Basic Information
| Provider Information | |||||||||
| NPI: | 1417063421 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBICHAUD | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 TOBIN DR | ||||||||
| Address2: | |||||||||
| City: | MAYNARD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017542164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783692266 | ||||||||
| FaxNumber: | 9783695205 | ||||||||
| Practice Location | |||||||||
| Address1: | 56 WINTHROP ST | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017422076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783692266 | ||||||||
| FaxNumber: | 9783695205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 1137 | MA | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 730539 | 01 | MA | TUFTS HEALTH PLANS | OTHER | 351105 | 01 | MA | HCHP PLANS | OTHER |