Healthcare Provider Details

I. General information

NPI: 1962671453
Provider Name (Legal Business Name): LIFEFORCE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 PROVIDENCE HWY SUITE 115
NORWOOD MA
02062-4662
US

IV. Provider business mailing address

1420 PROVIDENCE HWY SUITE 115
NORWOOD MA
02062-4662
US

V. Phone/Fax

Practice location:
  • Phone: 781-551-9119
  • Fax: 781-551-0220
Mailing address:
  • Phone: 781-551-9119
  • Fax: 781-551-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN SCOTT COOPER
Title or Position: PRESIDENT
Credential: DC, CSCS, RKC
Phone: 781-551-9119