Provider Demographics
NPI:1194861633
Name:AMY MOONEY, D.C.
Entity Type:Organization
Organization Name:AMY MOONEY, D.C.
Other - Org Name:AMY MOONEY, D.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEWELLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-897-0393
Mailing Address - Street 1:49 DARTMOUTH ST
Mailing Address - Street 2:101
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-1700
Mailing Address - Country:US
Mailing Address - Phone:207-828-8777
Mailing Address - Fax:207-828-8778
Practice Address - Street 1:117 GREAT RD
Practice Address - Street 2:GLOBAL FITNESS CENTER
Practice Address - City:STOW
Practice Address - State:MA
Practice Address - Zip Code:01775-1191
Practice Address - Country:US
Practice Address - Phone:978-897-0393
Practice Address - Fax:978-897-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2455111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY40038OtherBCBS GROUP
MA2503521OtherAETNA
MAY36775OtherBCBS OF MA INDIVIDUAL
MA351399OtherHPHC
MA80877OtherFALLON
MA6307932001OtherCIGNA
MA44-02698OtherUHC
MAY36775OtherBCBS OF MA INDIVIDUAL
MA=========OtherGUARDIAN
MAY40038OtherBCBS GROUP