Basic Information
Provider Information
NPI: 1003147331
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUGHES
FirstName: EVAN
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: DC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1740 MASSACHUSETTS AVE
Address2: SUITE 6
City: BOXBOROUGH
State: MA
PostalCode: 01719
CountryCode: US
TelephoneNumber: (978) 287-9546
FaxNumber:  
Practice Location
Address1: 1740 MASSACHUSETTS AVE
Address2:  
City: BOXBOROUGH
State: MA
PostalCode: 01719
CountryCode: US
TelephoneNumber: 9782879546
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/27/2010
LastUpdateDate: 05/22/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000X2895MAY Chiropractic ProvidersChiropractor 

No ID Information.


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