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General NPI Number Information
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NPI Number | 1073704607
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Entity Type | Organization
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Legal Business Name | BASS CHIROPRACTIC & PHYSICAL THERAPY
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 1145 MAIN ST SUITE 107
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City | SPRINGFIELD
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State | MA
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Zip | 01103-2143
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Country | US
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Telephone | 413-726-0912
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Fax | 413-686-9305
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Provider Business Mailing Address
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Address Line | 1145 MAIN ST SUITE 107
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City | SPRINGFIELD
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State | MA
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Zip | 01103-2143
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Country | US
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Telephone | 413-726-0912
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Fax | 413-686-9305
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BASSAM MAWLA
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Credential | D.C
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Telephone | 413-726-0912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 3120
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License Number State | MA
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