Provider Demographics
NPI:1831649128
Name:BOSTON GONSTEAD CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BOSTON GONSTEAD CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEONGHO
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-277-0648
Mailing Address - Street 1:77 POND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7115
Mailing Address - Country:US
Mailing Address - Phone:617-277-0648
Mailing Address - Fax:617-277-0696
Practice Address - Street 1:77 POND AVE STE 101
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7115
Practice Address - Country:US
Practice Address - Phone:617-277-0648
Practice Address - Fax:617-277-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty