Provider Demographics
NPI:1457514853
Name:J & M PRO P.C.
Entity Type:Organization
Organization Name:J & M PRO P.C.
Other - Org Name:COMMUNITY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PROVENZANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-689-0440
Mailing Address - Street 1:25 SCHOOL ST
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6607
Mailing Address - Country:US
Mailing Address - Phone:617-689-0440
Mailing Address - Fax:617-689-0420
Practice Address - Street 1:25 SCHOOL ST
Practice Address - Street 2:SUITE B-2
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-6607
Practice Address - Country:US
Practice Address - Phone:617-689-0440
Practice Address - Fax:617-689-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0005724Medicare PIN