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General NPI Number Information
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NPI Number | 1427396357
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Entity Type | Organization
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Legal Business Name | BOTTARY CHIROPRACTIC PROFESSIONAL LLC
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Dates
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Enumeration Date | 01/28/2013
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Last Update Date | 05/12/2020
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Provider Practice Location Address
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Address Line | 789 BELLEVILLE AVE
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City | NEW BEDFORD
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State | MA
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Zip | 02745-6126
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Country | US
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Telephone | 508-995-2000
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Fax | 781-826-0054
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Provider Business Mailing Address
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Address Line | 789 BELLEVILLE AVE
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City | NEW BEDFORD
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State | MA
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Zip | 02745-6126
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Country | US
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Telephone | 508-995-2000
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Fax | 781-826-0054
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIANE N BOTTARY
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Credential | DC
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Telephone | 508-995-2000
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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 | 2620
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License Number State | MA
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