Provider Demographics
NPI:1225301211
Name:CONNECTED LIFE CHIROPRACTIC
Entity Type:Organization
Organization Name:CONNECTED LIFE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DIROCCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-505-0395
Mailing Address - Street 1:10 AYER AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-4503
Mailing Address - Country:US
Mailing Address - Phone:978-505-0395
Mailing Address - Fax:
Practice Address - Street 1:1215 MAIN ST STE 111
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-4707
Practice Address - Country:US
Practice Address - Phone:978-455-3531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty