Provider Demographics
NPI:1770889016
Name:THISSELL, JUDAH BRIGGS (DC)
Entity type:Individual
Prefix:
First Name:JUDAH
Middle Name:BRIGGS
Last Name:THISSELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:45 NEWBURY ST
Mailing Address - Street 2:STE 333
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3133
Mailing Address - Country:US
Mailing Address - Phone:607-258-3001
Mailing Address - Fax:617-266-2183
Practice Address - Street 1:45 NEWBURY ST
Practice Address - Street 2:STE 333
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3133
Practice Address - Country:US
Practice Address - Phone:607-258-3001
Practice Address - Fax:617-266-2183
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2016-03-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA3423111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1770889016Medicare PIN