Healthcare Provider Details

I. General information

NPI: 1366412173
Provider Name (Legal Business Name): ADAM GREGORY WILBURN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 COLLEGE ST
AMHERST MA
01002-2391
US

IV. Provider business mailing address

379 COLLEGE ST
AMHERST MA
01002-2391
US

V. Phone/Fax

Practice location:
  • Phone: 413-253-2520
  • Fax:
Mailing address:
  • Phone: 413-253-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2775
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: