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NPI Code Detail

MEDICARE: JMSEJB1 LLC

MEDICARE: JMSEJB1 LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor001584CT
2111N00000XChiropractor001313CT

General Provider Information

NPI Number : 1467860635
Entity Type Code : Organization
Provider Name (Legal Business Name) : JMSEJB1 LLC
Provider Business Mailing Address
First Line : 24 LEWIS ST
Second Line :
City : HARTFORD
State : CT
Zip : 06103-2501
Country : US
Telephone Number : 860-278-9141
Fax Number : 860-525-4013
Provider Business Practice Location Address
First Line : 3034 SUMMER ST
Second Line :
City : STAMFORD
State : CT
Zip : 06905-4311
Country : US
Telephone Number : 860-278-9141
Fax Number : 860-525-4013
Authorized Official
Title or Position : MEMEBER
Name : DR. KARLOS BOGHOSIAN
Credential : D.C.
Telephone Number : 860-278-9141
Provider Enumeration Date : 07/31/2014
Last Update Date : 07/31/2014

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Directions to “JMSEJB1 LLC ” Practice Location

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