Healthcare Provider Details

I. General information

NPI: 1407272743
Provider Name (Legal Business Name): NLWC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WENDELL AVE SUITE 8
PITTSFIELD MA
01201-7065
US

IV. Provider business mailing address

100 WENDELL AVE SUITE 8
PITTSFIELD MA
01201-7065
US

V. Phone/Fax

Practice location:
  • Phone: 413-443-3577
  • Fax: 413-499-7852
Mailing address:
  • Phone: 413-443-3577
  • Fax: 413-499-7852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number611
License Number StateMA

VIII. Authorized Official

Name: DR. KURT HEINES SCHAGEN
Title or Position: SOLE MEMBER AND MANAGER
Credential: D.C.
Phone: 413-443-3577