Provider Demographics
NPI:1114388162
Name:BOSTON WELLNESS HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:BOSTON WELLNESS HEALTH CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PROFESSIONAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-822-0900
Mailing Address - Street 1:1377 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02122-2950
Mailing Address - Country:US
Mailing Address - Phone:617-822-0900
Mailing Address - Fax:617-822-0800
Practice Address - Street 1:1377 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02122-2950
Practice Address - Country:US
Practice Address - Phone:617-822-0900
Practice Address - Fax:617-822-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty