Healthcare Provider Details

I. General information

NPI: 1598804635
Provider Name (Legal Business Name): IMAGING DIAGNOSTICS IN MOTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BARTLEY HILL RD
LONDONDERRY NH
03053-2427
US

IV. Provider business mailing address

35 MANCHESTER RD SUITE 11A, PMB 113
DERRY NH
03038-3064
US

V. Phone/Fax

Practice location:
  • Phone: 603-437-9621
  • Fax:
Mailing address:
  • Phone: 603-437-9621
  • Fax: 866-265-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER BRISTOL
Title or Position: OWNER PRESIDENT
Credential: RDCS RVS CCT
Phone: 603-437-9621