Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DCP00666 | RI |
NPI | 1003393901 |
---|---|
Provider Name | Dr. Justin Belanger |
First Address | East Providence, RI 02914-4531 |
Second Address | Central Falls, RI 02863-1516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2018 |
Last Update Date | 24/07/2018 |