Healthcare Provider Details

I. General information

NPI: 1154355238
Provider Name (Legal Business Name): JAMIE M. ENOS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CALEF ST
WARWICK RI
02886-4345
US

IV. Provider business mailing address

12 CALEF ST
WARWICK RI
02886-4345
US

V. Phone/Fax

Practice location:
  • Phone: 401-921-6550
  • Fax: 401-921-6552
Mailing address:
  • Phone: 401-921-6550
  • Fax: 401-921-6552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDCP 00459
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: