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General NPI Number Information
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NPI Number | 1871860577
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Entity Type | Organization
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Legal Business Name | JMSEJB LLC
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 33 S 3RD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19106-2865
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Country | US
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Telephone | 215-928-9171
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Fax |
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Provider Business Mailing Address
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Address Line | 24 LEWIS ST
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City | HARTFORD
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State | CT
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Zip | 06103-2501
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. KARLOS BOGHOSIAN
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Credential |
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Telephone | 203-520-2211
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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 | DC010465
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License Number State | PA
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