Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 2775 | MA |
NPI | 1366412173 |
---|---|
Provider Name | Dr. Adam Gregory Wilburn |
First Address | Amherst, MA 01002-2391 |
Second Address | Amherst, MA 01002-2391 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2775 | STATE LICENSE NUMBER (01) | MA |
U70773 | (02) | |
Y36984 | BCBS OF MA (01) | MA |