Provider Demographics
NPI:1871860577
Name:JMSEJB LLC
Entity Type:Organization
Organization Name:JMSEJB LLC
Other - Org Name:PHILADELPHIA CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGHOSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-520-2211
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:
Mailing Address - Fax:
Practice Address - Street 1:33 S 3RD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2865
Practice Address - Country:US
Practice Address - Phone:215-928-9171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty