Provider Demographics
NPI:1043568132
Name:COUILLARD, ALBERT A (DC, BS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:A
Last Name:COUILLARD
Suffix:
Gender:M
Credentials:DC, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 RESERVOIR ST STE 3
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3132
Mailing Address - Country:US
Mailing Address - Phone:339-927-4379
Mailing Address - Fax:
Practice Address - Street 1:292 RESERVOIR ST STE 3
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3132
Practice Address - Country:US
Practice Address - Phone:339-927-4379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor