Provider Demographics
NPI:1730248428
Name:AMETHYST CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:AMETHYST CHIROPRACTIC, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HELENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEHAMER-GRAUT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-591-9200
Mailing Address - Street 1:259 ELM STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144
Mailing Address - Country:US
Mailing Address - Phone:617-591-9200
Mailing Address - Fax:617-591-8100
Practice Address - Street 1:259 ELM STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144
Practice Address - Country:US
Practice Address - Phone:617-591-9200
Practice Address - Fax:617-591-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
MA897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35824Medicare ID - Type Unspecified