=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578871075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST HILL SPINE AND SPORTS THERAPEUTICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2010
-----------------------------------------------------
Last Update Date | 09/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 852 PROSPECT ST
-----------------------------------------------------
City | PLANTSVILLE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06479-1011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-594-9372
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 KLARIDES VILLAGE DR
-----------------------------------------------------
City | SEYMOUR
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06483-2737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. WILLIE J LEVESQUE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 617-594-9372
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 001849
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------