Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038012737 | IL |
N | 175F00000X | Naturopath |
NPI | 1083096127 |
---|---|
Provider Name | Dr. Amanda Lynn Bose |
First Address | Addison, IL 60101-2035 |
Second Address | Addison, IL 60101-2035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2015 |
Last Update Date | 24/03/2017 |