Provider Demographics
NPI:1871574392
Name:MASTANDO, NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:MASTANDO
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 1:1020 PLAIN ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2157
Mailing Address - Country:US
Mailing Address - Phone:781-837-7300
Mailing Address - Fax:781-834-7330
Practice Address - Street 1:1020 PLAIN ST
Practice Address - Street 2:SUITE 140
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2157
Practice Address - Country:US
Practice Address - Phone:781-837-7300
Practice Address - Fax:781-834-7330
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2790111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA46029OtherHARVARD PILGRIM
MA1600681Medicaid
MA1101391OtherAETNA
MAY37029OtherBCBS OF MA
MA1101391OtherAETNA
MAMAY45692Medicare ID - Type UnspecifiedMEDICARE