Provider Demographics
NPI:1982760674
Name:AFANASENKO, NICOLAI (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLAI
Middle Name:
Last Name:AFANASENKO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 CHIEF JUSTICE CUSHING HWY
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-3627
Mailing Address - Country:US
Mailing Address - Phone:781-545-6644
Mailing Address - Fax:781-545-5744
Practice Address - Street 1:303 CHIEF JUSTICE CUSHING HWY
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-3627
Practice Address - Country:US
Practice Address - Phone:781-545-6644
Practice Address - Fax:781-545-5744
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45630Medicare ID - Type UnspecifiedMEDICARE #