1417145202 NPI number — BOS CHIROPRACTIC, PLLC

Table of content: (NPI 1417145202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417145202 NPI number — BOS CHIROPRACTIC, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOS CHIROPRACTIC, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417145202
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
793 N ALMA SCHOOL RD
Provider Second Line Business Mailing Address:
SUITE D5
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85224-3681
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-732-1000
Provider Business Mailing Address Fax Number:
480-323-2867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
793 N ALMA SCHOOL RD
Provider Second Line Business Practice Location Address:
SUITE D5
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85224-3681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-732-1000
Provider Business Practice Location Address Fax Number:
480-323-2867
Provider Enumeration Date:
10/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOS
Authorized Official First Name:
WILLEM
Authorized Official Middle Name:
E
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
480-732-1000

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5999 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1821299215 . This is a "PERSONAL NPI - WILLEM BOS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0939730 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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