Healthcare Provider Details

I. General information

NPI: 1275966822
Provider Name (Legal Business Name): ADVANCED WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 PURCHASE ST
NEW BEDFORD MA
02740-6634
US

IV. Provider business mailing address

427 PLYMOUTH AVE
FALL RIVER MA
02721-4231
US

V. Phone/Fax

Practice location:
  • Phone: 508-997-2900
  • Fax: 508-991-4432
Mailing address:
  • Phone: 508-679-0010
  • Fax: 508-672-4679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number816
License Number StateMA

VIII. Authorized Official

Name: DR. PAUL JOSEPH MCLAUGHLIN
Title or Position: ADMIN
Credential: D.C.
Phone: 508-997-2900