Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CHIRO07228 | GA |
NPI | 1215945597 |
---|---|
Provider Name | Dr. David Thomas Boczar |
First Address | Brunswick, GA 31525-1993 |
Second Address | Brunswick, GA 31525-1993 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 04/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U89959 | (02) | GA |