Healthcare Provider Details

I. General information

NPI: 1578964623
Provider Name (Legal Business Name): WELLNESS IN MOTION BOSTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/19/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 SCHOOL STREET GROUND FLOOR
BOSTON MA
02108
US

IV. Provider business mailing address

45 SCHOOL STREET GROUND FLOOR
BOSTON MA
02108
US

V. Phone/Fax

Practice location:
  • Phone: 857-305-3392
  • Fax: 857-305-3393
Mailing address:
  • Phone: 857-305-3392
  • Fax: 857-305-3393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: IAN A. NURSE
Title or Position: OWNER, CHIROPRACTIC PHYSICIAN
Credential: D.C.
Phone: 857-305-3392