MEDICARE: WELLSPACE ASSOCIATES, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2711	MA

General Provider Information

NPI Number	:	1932142965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPACE ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	1 NEW ST
Second Line	:	FRESH POND MALL
City	:	CAMBRIDGE
State	:	MA
Zip	:	02138-1222
Country	:	US
Telephone Number	:	617-876-2660
Fax Number	:	617-451-5552

Provider Business Practice Location Address
First Line	:	1 NEW ST
Second Line	:	FRESH POND MALL
City	:	CAMBRIDGE
State	:	MA
Zip	:	02138-1222
Country	:	US
Telephone Number	:	617-876-2660
Fax Number	:	617-451-5552

Authorized Official
Title or Position	:	TEAM LEADER CHIROPRACTIC SERVICES
Name	:	DR. ROBERT N KUM
Credential	:	D.C.
Telephone Number	:	617-876-2660

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	08/22/2020

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