Provider Demographics
NPI:1912412735
Name:BRISTOL CHIROPRACTIC OFFICE LLC
Entity Type:Organization
Organization Name:BRISTOL CHIROPRACTIC OFFICE LLC
Other - Org Name:SOVITA CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
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:
Practice Address - Street 1:281 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4971
Practice Address - Country:US
Practice Address - Phone:860-582-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty