Provider Demographics
NPI:1295919942
Name:ALIVE & WELL CHIROPRACTIC, INC
Entity type:Organization
Organization Name:ALIVE & WELL CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCELLINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC , CCEP
Authorized Official - Phone:781-942-7121
Mailing Address - Street 1:2 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867
Mailing Address - Country:US
Mailing Address - Phone:781-942-7121
Mailing Address - Fax:
Practice Address - Street 1:2 LINDEN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-2940
Practice Address - Country:US
Practice Address - Phone:781-942-7121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA250259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY40032OtherBLUE CROSS BLUE SHIELD
MAY40032OtherBLUE CROSS BLUE SHIELD