Healthcare Provider Details

I. General information

NPI: 1376946046
Provider Name (Legal Business Name): MICHAEL J BOZAN DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 PARK AVE
EAST RUTHERFORD NJ
07073-1918
US

IV. Provider business mailing address

237 PARK AVE
EAST RUTHERFORD NJ
07073-1918
US

V. Phone/Fax

Practice location:
  • Phone: 201-438-7474
  • Fax: 201-438-8255
Mailing address:
  • Phone: 201-438-7474
  • Fax: 201-438-8255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00462300
License Number StateNJ

VIII. Authorized Official

Name: MICHAEL J BOZAN
Title or Position: PRESIDENT/OWNER
Credential: DC
Phone: 201-438-7474