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General NPI Number Information
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NPI Number | 1265573851
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Entity Type | Organization
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Legal Business Name | TRUE LIFE CHIROPRACTIC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 283 MAIN ST
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City | KINGSTON
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State | MA
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Zip | 02364-1910
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Country | US
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Telephone | 781-585-0585
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Fax | 781-585-0586
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Provider Business Mailing Address
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Address Line | 283 MAIN ST
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City | KINGSTON
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State | MA
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Zip | 02364-1910
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Country | US
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Telephone | 781-585-0585
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Fax | 781-585-0586
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUSAN FRANCES WALETKUS
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Credential | DC
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Telephone | 781-585-0585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1946
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License Number State | MA
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