Organization
PROHEALTH CHIROPRACTIC CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON ALLEN SOUSA D.C. (OWNER CHIROPRACTOR)
(860) 432-7432
Entity
Organization
Contact information
Practice address
1127 TOLLAND TURNPIKE, SUITE 102, MANCHESTER, CT 06042
(860) 432-7432
(860) 432-7432
Mailing address
1127 TOLLAND TURNPIKE, SUITE 102, MANCHESTER, CT 06042
(860) 432-7432
(860) 432-9049
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
001722
CT
111N00000X
Chiropractor
Primary
001726
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432191999
—
ME
01
—
C03898
GROUP MEDICARE
—
01
—
ME1910
MEDICARE PROVIDER NUMBER
ME
Enumeration date
01/18/2008
Last updated
07/16/2008
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