Healthcare Provider Details

I. General information

NPI: 1174953152
Provider Name (Legal Business Name): DC INSURANCE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 SCHOOL ST SUITE 1
QUINCY MA
02169-6640
US

IV. Provider business mailing address

21 SCHOOL ST SUITE 1
QUINCY MA
02169-6640
US

V. Phone/Fax

Practice location:
  • Phone: 860-839-4508
  • Fax:
Mailing address:
  • Phone: 860-839-4508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAVID TKHILAISHVILI
Title or Position: PRINCIPAL
Credential:
Phone: 860-839-4508