Provider Demographics
NPI:1962746354
Name:BMS22-INC.
Entity type:Organization
Organization Name:BMS22-INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:SANGIAMO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-594-2552
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-0458
Mailing Address - Country:US
Mailing Address - Phone:610-594-2552
Mailing Address - Fax:610-594-2559
Practice Address - Street 1:43 MARCHWOOD RD STE 1
Practice Address - Street 2:MARCHWOOD CENTER
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1842
Practice Address - Country:US
Practice Address - Phone:610-594-2552
Practice Address - Fax:610-594-2559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-005947-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU72312Medicare UPIN
PASA019999Medicare PIN