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General NPI Number Information
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NPI Number | 1679642763
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Entity Type | Organization
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Legal Business Name | JAGGN LLC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 06/19/2015
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Provider Practice Location Address
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Address Line | 2 OLD DERRY ROAD
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City | HUDSON
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State | NH
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Zip | 03051
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Country | US
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Telephone | 603-882-7769
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Fax | 603-598-8206
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Provider Business Mailing Address
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Address Line | 2 OLD DERRY RD
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City | HUDSON
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State | NH
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Zip | 03051-3309
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Country | US
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Telephone | 603-882-7769
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Fax | 603-598-8206
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Authorized Official
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Title or Position | OWNER DC
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Name | DR. ROGER LEON GOSSELIN
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Credential | DC
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Telephone | 603-882-7769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0791091A
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License Number State | NH
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