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JASON ALLEN SOUSA DC
>> Chiropractor >> Chiropractic ProvidersRegistrant NPI Number: 1558439398
Individual Registrant: JASON ALLEN SOUSA DC
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
1127 TOLLAND TURNPIKE SUITE 102 MANCHESTER, CO 06042 US
Tel: 860-432-7432 Fax: 860-432-9049
Tel: 860-432-7432 Fax: 860-432-9049
Contact information for business:
1127 TOLLAND TURNPIKE SUITE 102 MANCHESTER, CO 06042 US
Tel: 860-432-7432 Fax: 860-432-9049
Tel: 860-432-7432 Fax: 860-432-9049
Registration Information:
NPI: 1558439398
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 111N00000X | Chiropractic Providers Chiropractor | ME | CR1692 |
| N | 111N00000X | Chiropractic Providers Chiropractor | CT | 001722 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| GROUP MEDICARE | C03898 | 01 | |
| LICENSE | CR1692 | ME | 01 |
