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General NPI Number Information
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NPI Number | 1962746354
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Entity Type | Organization
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Legal Business Name | BMS22-INC.
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Dates
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Enumeration Date | 11/26/2012
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 43 MARCHWOOD RD STE 1 MARCHWOOD CENTER
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City | EXTON
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State | PA
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Zip | 19341-1842
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Country | US
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Telephone | 610-594-2552
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Fax | 610-594-2559
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Provider Business Mailing Address
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Address Line | PO BOX 458
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City | EXTON
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State | PA
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Zip | 19341-0458
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Country | US
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Telephone | 610-594-2552
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Fax | 610-594-2559
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Authorized Official
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Title or Position | PRESIDENT/ CHIROPRACTOR
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Name | DR. JERRY STEVEN SANGIAMO
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Credential | D.C.
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Telephone | 610-594-2552
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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 | DC-005947-L
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License Number State | PA
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