Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 184 | MA |
NPI | 1003825464 |
---|---|
Provider Name | Kenneth Sereno Pompilli |
First Address | Florence, MA 01062-1464 |
Second Address | Florence, MA 01062-1464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 10/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
351093 | HARVARD PILGRIM (01) | MA |
Y35060 | BCBS OF MA (01) | MA |