Healthcare Provider Details

I. General information

NPI: 1518250083
Provider Name (Legal Business Name): AMITY BUBBINS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 STATE RD
PLYMOUTH MA
02360-5123
US

IV. Provider business mailing address

1450 STATE RD
PLYMOUTH MA
02360-5123
US

V. Phone/Fax

Practice location:
  • Phone: 508-237-5825
  • Fax:
Mailing address:
  • Phone: 508-237-5825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3290
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: