# AMERICAN MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043513427
- **Authorized official:** DR. MARK LIQUE DC (PRESIDENT)
- **Authorized official phone:** (617) 522-9200

## Contact information

- **Practice address:** 408 S HUNTINGTON AVE, JAMAICA PLAIN, MA 02130-4814
- **Practice address phone:** (617) 522-9200
- **Practice address fax:** (617) 522-0088
- **Mailing address:** 408 S HUNTINGTON AVE, JAMAICA PLAIN, MA 02130-4814
- **Mailing address phone:** (617) 522-9200
- **Mailing address fax:** (617) 522-0088

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NR0400X | Rehabilitation Chiropractor | 2921 | MA | Yes |

## Other

- **Enumeration date:** 12/07/2010
- **Last updated:** 12/07/2010