Organization
AMERICAN MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK LIQUE DC (PRESIDENT)
(617) 522-9200
Entity
Organization
Contact information
Practice address
408 S HUNTINGTON AVE, JAMAICA PLAIN, MA 02130-4814
(617) 522-9200
(617) 522-0088
Mailing address
408 S HUNTINGTON AVE, JAMAICA PLAIN, MA 02130-4814
(617) 522-9200
(617) 522-0088
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
2921
MA
Other
Enumeration date
12/07/2010
Last updated
12/07/2010
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