Healthcare Provider Details

I. General information

NPI: 1831231471
Provider Name (Legal Business Name): MELISSA ANN BOSCH DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S BROADWAY
SALISBURY MO
65281
US

IV. Provider business mailing address

2407 COUNTY RD 1430
CAIRO MO
65239
US

V. Phone/Fax

Practice location:
  • Phone: 660-388-5819
  • Fax: 660-388-6930
Mailing address:
  • Phone: 660-269-8328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006390
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: