Healthcare Provider Details

I. General information

NPI: 1992043293
Provider Name (Legal Business Name): DANA PEMBERTON D.C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2013
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WILLARD ST STE 2A
QUINCY MA
02169-1274
US

IV. Provider business mailing address

111 WILLARD ST STE 2A
QUINCY MA
02169-1274
US

V. Phone/Fax

Practice location:
  • Phone: 617-471-4491
  • Fax: 617-471-1114
Mailing address:
  • Phone: 617-471-4491
  • Fax: 617-471-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3407
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: