Healthcare Provider Details

I. General information

NPI: 1730248428
Provider Name (Legal Business Name): AMETHYST CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 ELM STREET SUITE 300
SOMERVILLE MA
02144
US

IV. Provider business mailing address

259 ELM STREET SUITE 300
SOMERVILLE MA
02144
US

V. Phone/Fax

Practice location:
  • Phone: 617-591-9200
  • Fax: 617-591-8100
Mailing address:
  • Phone: 617-591-9200
  • Fax: 617-591-8100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number897
License Number StateMA

VIII. Authorized Official

Name: HELENA M. DEHAMER-GRAUT
Title or Position: DR/OWNER
Credential: D.C.
Phone: 617-591-9200