Provider Demographics
NPI:1366623076
Name:LIFE 4ORCE CHIRO, INC
Entity Type:Organization
Organization Name:LIFE 4ORCE CHIRO, INC
Other - Org Name:LIFE 4ORCE CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLEEN
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:AMATO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-221-2295
Mailing Address - Street 1:175 CAMBRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803
Mailing Address - Country:US
Mailing Address - Phone:781-221-2295
Mailing Address - Fax:781-221-2296
Practice Address - Street 1:175 CAMBRIDGE STREET
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803
Practice Address - Country:US
Practice Address - Phone:781-221-2295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY49152Medicare PIN