Healthcare Provider Details

I. General information

NPI: 1588187249
Provider Name (Legal Business Name): HEALTH FOR LIFE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 ARSENAL ST STE 4
WATERTOWN MA
02472-2898
US

IV. Provider business mailing address

352 BOSTON TPKE
SHREWSBURY MA
01545-3873
US

V. Phone/Fax

Practice location:
  • Phone: 617-926-0272
  • Fax: 617-926-5430
Mailing address:
  • Phone: 508-425-3304
  • Fax: 508-425-3306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MS. CHARLENE HOLLUM
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 508-425-3304