Provider Demographics
NPI:1437365806
Name:TIBBETTS, NEIL R (DC)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:R
Last Name:TIBBETTS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 BURNCOAT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-1407
Mailing Address - Country:US
Mailing Address - Phone:508-852-0800
Mailing Address - Fax:508-852-0829
Practice Address - Street 1:487 BURNCOAT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1407
Practice Address - Country:US
Practice Address - Phone:508-852-0800
Practice Address - Fax:508-852-0829
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor