Healthcare Provider Details

I. General information

NPI: 1588506398
Provider Name (Legal Business Name): JADE NICOLE CARBUCCIA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 BOYLSTON ST STE 301
BOSTON MA
02116-3827
US

IV. Provider business mailing address

10860 HORACE HARDING EXPY APT 6C
FOREST HILLS NY
11375-4389
US

V. Phone/Fax

Practice location:
  • Phone: 857-250-2939
  • Fax:
Mailing address:
  • Phone: 516-384-6299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHI5228
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: