Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5352847-1202 | UT |
NPI | 1013020213 |
---|---|
Provider Name | Ryan Bosley |
First Address | Ogden, UT 84403-2038 |
Second Address | Ogden, UT 84403-2038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U97528 | (02) | UT |