MEDICARE: TOTAL HEALTH HOLISTIC CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2269	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4404288	OTHER	MA	UNITED HEALTH CARE
3	9228734	OTHER	MA	PHCS
4	798431	OTHER	MA	TUFTS HEALTH PLAN
5	Y36596	OTHER	MA	BC/BS OF MA INDIVIDUAL ID
6	033487192	OTHER	MA	HCVM
7	27243	OTHER	MA	NEIGHBORHOOD HEALTH PLAN
8	1867401004	OTHER	MA	CIGNA HEALTH CARE
9	2859278	OTHER	MA	AETNA/US HEALTHCARE
10	974044	OTHER	MA	NETWORK HEALTH PLAN
11	Y39715	OTHER	MA	BC/BS OF MA GROUP ID
12	351902	OTHER	MA	HARVARD PILGRIM

General Provider Information

NPI Number	:	1578549978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL HEALTH HOLISTIC CENTER, INC.

Provider Business Mailing Address
First Line	:	24 HOLLAND RD APT 1
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01603-1858
Country	:	US
Telephone Number	:	978-821-7054
Fax Number	:	774-208-0712

Provider Business Practice Location Address
First Line	:	24 HOLLAND RD APT 1
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01603-1858
Country	:	US
Telephone Number	:	978-821-7054
Fax Number	:	774-208-0712

Authorized Official
Title or Position	:	OWNER
Name	:	KAREN LYNN ST.LAURENT
Credential	:
Telephone Number	:	978-821-7054

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	06/24/2021

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