Provider Demographics
NPI:1720024268
Name:BROOKLINE NEWTON WHOLE HEALTH CENTER
Entity Type:Organization
Organization Name:BROOKLINE NEWTON WHOLE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-413-8362
Mailing Address - Street 1:PO BOX 320258
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-0003
Mailing Address - Country:US
Mailing Address - Phone:617-413-8362
Mailing Address - Fax:
Practice Address - Street 1:960 CENTRE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3045
Practice Address - Country:US
Practice Address - Phone:617-413-8362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1405111N00000X
MA2710111N00000X
MA3064111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA35472OtherDEBORAH WU HPHC
MAY39428OtherBCBS GROUP
MA3830317OtherLYDIE COLEMAN AETNA
MA2490916OtherDEBORAH WU AETNA
MA31221OtherLYDIE COLEMAN HPHC
MA44-00391OtherDEBORAH WU UNITED HC/ACN
MA668803OtherLYDIE COLEMAN UNITED HC
MA=========OtherCIGNA
MA=========OtherHCVM
MA=========OtherHCVM
MA668803OtherLYDIE COLEMAN UNITED HC
MA=========OtherCIGNA
MAY36023Medicare ID - Type UnspecifiedDEBORAH WU
MAY45567Medicare ID - Type UnspecifiedLYDIE COLEMAN