Healthcare Provider Details

I. General information

NPI: 1871860577
Provider Name (Legal Business Name): JMSEJB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 S 3RD ST
PHILADELPHIA PA
19106-2865
US

IV. Provider business mailing address

24 LEWIS ST
HARTFORD CT
06103-2501
US

V. Phone/Fax

Practice location:
  • Phone: 215-928-9171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC010465
License Number StatePA

VIII. Authorized Official

Name: DR. KARLOS BOGHOSIAN
Title or Position: MEMBER
Credential:
Phone: 203-520-2211