Healthcare Provider Details

I. General information

NPI: 1649568841
Provider Name (Legal Business Name): BYUS FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 S MAIN ST
CAMBRIDGE VT
05444-9773
US

IV. Provider business mailing address

249 S MAIN ST
CAMBRIDGE VT
05444-9773
US

V. Phone/Fax

Practice location:
  • Phone: 802-644-2260
  • Fax: 802-644-5746
Mailing address:
  • Phone: 802-644-2260
  • Fax: 802-644-5746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0060079419
License Number StateVT

VIII. Authorized Official

Name: MATTHEW WILLIAM BYUS
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 802-644-2260