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General NPI Number Information
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NPI Number | 1194861633
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Entity Type | Organization
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Legal Business Name | AMY MOONEY, D.C.
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 11/12/2008
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Provider Practice Location Address
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Address Line | 117 GREAT RD GLOBAL FITNESS CENTER
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City | STOW
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State | MA
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Zip | 01775-1191
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Country | US
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Telephone | 978-897-0393
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Fax | 978-897-3110
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Provider Business Mailing Address
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Address Line | 49 DARTMOUTH ST 101
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City | PORTLAND
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State | ME
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Zip | 04101-1700
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Country | US
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Telephone | 207-828-8777
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Fax | 207-828-8778
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMY M LEWELLEN
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Credential | D.C.
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Telephone | 978-897-0393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2455
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License Number State | MA
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