Provider Demographics
NPI:1427396357
Name:BOTTARY CHIROPRACTIC PROFESSIONAL LLC
Entity Type:Organization
Organization Name:BOTTARY CHIROPRACTIC PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:N
Authorized Official - Last Name:BOTTARY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-995-2000
Mailing Address - Street 1:789 BELLEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-6126
Mailing Address - Country:US
Mailing Address - Phone:508-995-2000
Mailing Address - Fax:781-826-0054
Practice Address - Street 1:789 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-6126
Practice Address - Country:US
Practice Address - Phone:508-995-2000
Practice Address - Fax:781-826-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty