| NPI | 1528764131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARRETT MICHAEL LEATHEM Do Owner 860-670-2412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine |
| Additional Taxonomies | 111N00000X Chiropractor |
| 207LP2900X Anesthesiology Pain Medicine | |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine | |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2023-02-06 |