Provider Demographics
NPI:1225466741
Name:SOUTHCOAST JOINT & WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:SOUTHCOAST JOINT & WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:VIVEIROS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:508-837-1493
Mailing Address - Street 1:651 ORCHARD ST
Mailing Address - Street 2:STE 202A
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02744-1008
Mailing Address - Country:US
Mailing Address - Phone:508-837-1493
Mailing Address - Fax:
Practice Address - Street 1:651 ORCHARD ST
Practice Address - Street 2:STE 202A
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02744-1008
Practice Address - Country:US
Practice Address - Phone:508-837-1493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty