Organization
BROOKSIDE RADIOLOGY CONSULTANTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN RAYMOND HENRY D.C. D.A.C.B.R. (CHIEF RADIOLOGIST)
(508) 743-5691
Entity
Organization
Contact information
Practice address
62 BROOKSIDE RD, BOURNE, MA 02532-8315
(508) 743-5691
Mailing address
62 BROOKSIDE RD, BOURNE, MA 02532-8315
(508) 743-5691
Taxonomy
Speciality
Code
Description
License number
State
111NR0200X
Radiology Chiropractor
Primary
CH2416
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y45291
MEDICARE ID-TYPE UNSPECIFIED
MA
Enumeration date
04/21/2014
Last updated
04/21/2014
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