Provider Demographics
NPI:1295857183
Name:CIRCLE OF LIFE CHIROPRACTIC, CO. INC.
Entity Type:Organization
Organization Name:CIRCLE OF LIFE CHIROPRACTIC, CO. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAPONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-331-6040
Mailing Address - Street 1:775 PLEASANT ST STE 9
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-2355
Mailing Address - Country:US
Mailing Address - Phone:781-331-6040
Mailing Address - Fax:339-499-6055
Practice Address - Street 1:775 PLEASANT ST STE 9
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-2355
Practice Address - Country:US
Practice Address - Phone:781-331-6040
Practice Address - Fax:339-499-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH2337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1104974872OtherNPI FOR ENTITY 1