Robert Mirandola, D.C.

Individual provider Active NPI Chiropractor · Newtonville, MA

NPI 1376872069 · NPPES record last updated Dec 9, 2009

Key facts

NPI
1376872069
Entity type
Individual (NPI type 1)
Primary specialty
Chiropractor 111N00000X
License
3249 (MA)
Practice address
46 Austin St
Suite 101
Newtonville, MA 02460-1861
Phone
(847) 308-3031
NPI assigned
Dec 9, 2009
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
3249MAMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Allasso Chiropractic Chiropractor Past
since Feb 18, 2010
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3249 MA Yes

Addresses

Primary practice location

46 Austin St
Suite 101
Newtonville, MA 02460-1861

Mailing address

46 Austin St
Suite 101
Newtonville, MA 02460-1861
Phone (847) 308-3031

Other providers in Newtonville, MA

All providers in Newtonville, MA · Chiropractor in Massachusetts

Sources for this page

Verify at the official NPI Registry.