Provider Demographics
NPI:1265573851
Name:TRUE LIFE CHIROPRACTIC
Entity type:Organization
Organization Name:TRUE LIFE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:WALETKUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-585-0585
Mailing Address - Street 1:283 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1910
Mailing Address - Country:US
Mailing Address - Phone:781-585-0585
Mailing Address - Fax:781-585-0586
Practice Address - Street 1:283 MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1910
Practice Address - Country:US
Practice Address - Phone:781-585-0585
Practice Address - Fax:781-585-0586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA35851OtherHARVARD PILGRIM
MAY39589OtherBCBS
MA1612905Medicaid
MA402656OtherTUFTS
MAY36466OtherBCBS
MAU58872OtherFIRST SENIORITY
MA0018410OtherNEIGHBORHOOD
MAU58872OtherFIRST SENIORITY