Provider Demographics
NPI:1275966822
Name:ADVANCED WELLNESS
Entity Type:Organization
Organization Name:ADVANCED WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-997-2900
Mailing Address - Street 1:427 PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-4231
Mailing Address - Country:US
Mailing Address - Phone:508-679-0010
Mailing Address - Fax:508-672-4679
Practice Address - Street 1:1155 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6634
Practice Address - Country:US
Practice Address - Phone:508-997-2900
Practice Address - Fax:508-991-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1871677187Medicaid
MA1871677187Medicare NSC