Organization
LIFE CLINIC OF MA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALBERT COUILLARD DC (PRESIDENT)
(339) 927-4379
Entity
Organization
Contact information
Practice address
300 BOYLSTON ST, CHESTNUT HILL, MA 02467-1959
(339) 927-4379
Mailing address
PO BOX 686, CHANHASSEN, MN 55317-0686
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3387
MA
225100000X
Physical Therapist
22574
MA
Other
Enumeration date
06/15/2017
Last updated
06/26/2019
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