Provider Demographics
NPI:1467860635
Name:JMSEJB1 LLC
Entity Type:Organization
Organization Name:JMSEJB1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMEBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGHOSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-278-9141
Mailing Address - Street 1:24 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-2501
Mailing Address - Country:US
Mailing Address - Phone:860-278-9141
Mailing Address - Fax:860-525-4013
Practice Address - Street 1:3034 SUMMER ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-4311
Practice Address - Country:US
Practice Address - Phone:860-278-9141
Practice Address - Fax:860-525-4013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001584111N00000X
CT001313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty