Provider Demographics
NPI:1447323720
Name:TIBBETTS, WILLIAM C (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
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 1:7 BOW ST
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-2534
Mailing Address - Country:US
Mailing Address - Phone:978-664-6888
Mailing Address - Fax:978-664-9777
Practice Address - Street 1:7 BOW ST
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-2534
Practice Address - Country:US
Practice Address - Phone:978-664-6888
Practice Address - Fax:978-664-9777
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36437OtherBCBS OF MA INDIVIDUAL ID
MAY45060Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID