Healthcare Provider Details

I. General information

NPI: 1376559807
Provider Name (Legal Business Name): JIM GUO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 NEWPORT AVE
SOUTH ATTLEBORO MA
02703-5625
US

IV. Provider business mailing address

668 NEWPORT AVE
SOUTH ATTLEBORO MA
02703-5625
US

V. Phone/Fax

Practice location:
  • Phone: 508-399-8880
  • Fax: 508-399-8881
Mailing address:
  • Phone: 508-399-8880
  • Fax: 508-399-8881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2262
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: