Provider Demographics
NPI:1376559807
Name:GUO, JIM (DC)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:
Last Name:GUO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-5625
Mailing Address - Country:US
Mailing Address - Phone:508-399-8880
Mailing Address - Fax:508-399-8881
Practice Address - Street 1:668 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-5625
Practice Address - Country:US
Practice Address - Phone:508-399-8880
Practice Address - Fax:508-399-8881
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36582OtherBCBSMA
MAY39931OtherBCBSMA GROUP
RI29905OtherBCBSRI
MA1376763383OtherNPI FED ID ACUPUNCTURE CH
RI404715OtherBLUE CHIP
RI29905OtherBCBSRI
MAY39931OtherBCBSMA GROUP