Provider Demographics
NPI:1457344848
Name:COLEMAN, LYDIE (DC)
Entity Type:Individual
Prefix:DR
First Name:LYDIE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 HIGHLAND CIR STE E
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3031
Mailing Address - Country:US
Mailing Address - Phone:781-455-0040
Mailing Address - Fax:781-455-7999
Practice Address - Street 1:13 HIGHLAND CIR STE E
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3031
Practice Address - Country:US
Practice Address - Phone:781-455-0040
Practice Address - Fax:781-455-7999
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA2710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAV02527Medicare UPIN
MAY45567Medicare ID - Type Unspecified