Healthcare Provider Details

I. General information

NPI: 1194861633
Provider Name (Legal Business Name): AMY MOONEY, D.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 GREAT RD GLOBAL FITNESS CENTER
STOW MA
01775-1191
US

IV. Provider business mailing address

49 DARTMOUTH ST 101
PORTLAND ME
04101-1700
US

V. Phone/Fax

Practice location:
  • Phone: 978-897-0393
  • Fax: 978-897-3110
Mailing address:
  • Phone: 207-828-8777
  • Fax: 207-828-8778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2455
License Number StateMA

VIII. Authorized Official

Name: DR. AMY M LEWELLEN
Title or Position: OWNER
Credential: D.C.
Phone: 978-897-0393