Life Clinic of Ma PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3387 Issued in MA

Legal business name

LIFE CLINIC OF MA PC

Practice address

300 Boylston St
Chestnut Hill, MA 02467-1959

Phone

(339) 927-4379

NPI assigned

Jun 15, 2017

Last updated

Jun 26, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Albert Couillard, DCNPI 1043568132

Title

President

Phone

(339) 927-4379

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Scott Durdin, DC

  • Chiropractor
  • Weymouth, MA
  • NPI 1780216382
  Medicare reassignment NPD
• Timothy J Kistler, D.C.

  • Chiropractor
  • Quincy, MA
  • NPI 1043366347
  Medicare reassignment NPD
• Adam Musa Al-Haraizeh, D.C

  • Chiropractor
  • Pine Bush, NY
  • NPI 1043901382

  MA

  Medicare reassignment NPD
• Donald Levin

  • Chiropractor
  • Austin, TX
  • NPI 1811362734

  MA

  Medicare reassignment NPD
• Albert A Couillard, D.C, B.S

  • Chiropractor
  • Needham, MA
  • NPI 1043568132
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561507200000",
    "number": "1225568975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 686",
            "city": "CHANHASSEN",
            "state": "MN",
            "postal_code": "553170686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 BOYLSTON ST",
            "city": "CHESTNUT HILL",
            "state": "MA",
            "postal_code": "024671959",
            "telephone_number": "339-927-4379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CLINIC OF MA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-15",
        "last_updated": "2019-06-26",
        "status": "A",
        "authorized_official_last_name": "COUILLARD",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "339-927-4379",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MA",
            "license": "3387",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "22574",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chotinij Lertphanichkul, MD
• Donald B Levy, MD
• Belle Liang, PH.D.
• Ying Liang
• Taryn Ann Lieberman, MD
• Lifestyle Medical and Cardiovascular Associates PC (Synergy Private Health)
• Jennifer Christie Lim, RN
• Fleurette Lincy, RN
• Patricia M Lines, NP
• Mark H Lipof, LICSW

• Chiropractor in Chestnut Hill, MA
• Providers in Chestnut Hill, MA by specialty
• Chiropractor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.