Individual
JASON ALLEN SOUSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1127 TOLLAND TURNPIKE, SUITE 102, MANCHESTER, CO 06042
(860) 432-7432
(860) 432-9049
Mailing address
1127 TOLLAND TURNPIKE, SUITE 102, MANCHESTER, CO 06042
(860) 432-7432
(860) 432-9049
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
001722
CT
111N00000X
Chiropractor
Primary
CR1692
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C03898
GROUP MEDICARE
—
01
—
CR1692
LICENSE
ME
Enumeration date
12/01/2006
Last updated
07/08/2008
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