Provider Demographics
NPI:1992043293
Name:PEMBERTON, DANA (DC)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:PEMBERTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WILLARD ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1274
Mailing Address - Country:US
Mailing Address - Phone:617-471-4491
Mailing Address - Fax:617-471-1114
Practice Address - Street 1:111 WILLARD ST STE 2A
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1274
Practice Address - Country:US
Practice Address - Phone:617-471-4491
Practice Address - Fax:617-471-1114
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor