Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH60036331 | WA |
NPI | 1003066507 |
---|---|
Provider Name | Dr. Michael John Bostjancic |
First Address | Kent, WA 98031-5545 |
Second Address | Kent, WA 98031-5545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2008 |
Last Update Date | 23/09/2008 |