Healthcare Provider Details

I. General information

NPI: 1578549978
Provider Name (Legal Business Name): TOTAL HEALTH HOLISTIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOLLAND RD APT 1
WORCESTER MA
01603-1858
US

IV. Provider business mailing address

24 HOLLAND RD APT 1
WORCESTER MA
01603-1858
US

V. Phone/Fax

Practice location:
  • Phone: 978-821-7054
  • Fax: 774-208-0712
Mailing address:
  • Phone: 978-821-7054
  • Fax: 774-208-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2269
License Number StateMA

VIII. Authorized Official

Name: KAREN LYNN ST.LAURENT
Title or Position: OWNER
Credential:
Phone: 978-821-7054