1588187249 NPI number — HEALTH FOR LIFE, PC

Table of content: (NPI 1588187249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588187249 NPI number — HEALTH FOR LIFE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH FOR LIFE, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588187249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
352 BOSTON TPKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREWSBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01545-3873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-425-3304
Provider Business Mailing Address Fax Number:
508-425-3306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 ARSENAL ST STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02472-2898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-926-0272
Provider Business Practice Location Address Fax Number:
617-926-5430
Provider Enumeration Date:
07/24/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLUM
Authorized Official First Name:
CHARLENE
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
508-425-3304

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 924 . This is a "INDIVIDUAL CHIROPRACTIC LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com