Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH0006738 | FL |
NPI | 1215089834 |
---|---|
Provider Name | Dr. John Jeffrey Bos |
First Address | Winter Springs, FL 32708-5204 |
Second Address | Winter Springs, FL 32708-5289 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 01/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55534 | BCBS (01) | FL |