Provider Demographics
NPI:1962671453
Name:LIFEFORCE HEALTH CENTER
Entity Type:Organization
Organization Name:LIFEFORCE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CSCS, RKC
Authorized Official - Phone:781-551-9119
Mailing Address - Street 1:1420 PROVIDENCE HWY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-4662
Mailing Address - Country:US
Mailing Address - Phone:781-551-9119
Mailing Address - Fax:781-551-0220
Practice Address - Street 1:1420 PROVIDENCE HWY
Practice Address - Street 2:SUITE 115
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4662
Practice Address - Country:US
Practice Address - Phone:781-551-9119
Practice Address - Fax:781-551-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39412OtherBCBS
MAY39412OtherBCBS
U74900Medicare PIN