Healthcare Provider Details

I. General information

NPI: 1508942657
Provider Name (Legal Business Name): KATHY J BOSCH DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19515 VILLAGE DR STE B
SONORA CA
95370-9270
US

IV. Provider business mailing address

19595 VILLAGE DR STE B
SONORA CA
95370
US

V. Phone/Fax

Practice location:
  • Phone: 209-533-4330
  • Fax: 209-532-5374
Mailing address:
  • Phone: 209-533-4330
  • Fax: 209-532-5374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC012363
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC12363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: