Provider Demographics
NPI:1780743203
Name:MAGAURAN, MARY (DC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:MAGAURAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 UPCREST RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1725
Mailing Address - Country:US
Mailing Address - Phone:617-591-9200
Mailing Address - Fax:617-591-8100
Practice Address - Street 1:259 ELM ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2950
Practice Address - Country:US
Practice Address - Phone:617-591-9200
Practice Address - Fax:617-591-8100
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45468Medicare ID - Type Unspecified