Provider Demographics
NPI:1265672828
Name:MUTTER, KANDYCE AMANDA JEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KANDYCE
Middle Name:AMANDA JEAN
Last Name:MUTTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:83 CAMBRIDGE ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4157
Mailing Address - Country:US
Mailing Address - Phone:781-365-0400
Mailing Address - Fax:781-272-2442
Practice Address - Street 1:83 CAMBRIDGE ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4157
Practice Address - Country:US
Practice Address - Phone:781-365-0400
Practice Address - Fax:781-272-2442
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA3164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor