Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 38MC00134400 | NJ |
NPI | 1245449826 |
---|---|
Provider Name | Charles Bruce Boas |
First Address | Bayonne, NJ 07002-3051 |
Second Address | Bayonne, NJ 07002-3051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |