Provider Demographics
NPI:1780114702
Name:LIVING WELL AFFILIATED HEALTH PROFESSIONALS, INC
Entity type:Organization
Organization Name:LIVING WELL AFFILIATED HEALTH PROFESSIONALS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:978-740-9355
Mailing Address - Street 1:207 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3607
Mailing Address - Country:US
Mailing Address - Phone:978-740-9355
Mailing Address - Fax:
Practice Address - Street 1:207 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3607
Practice Address - Country:US
Practice Address - Phone:978-740-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA249993171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty