Healthcare Provider Details

I. General information

NPI: 1568406072
Provider Name (Legal Business Name): CHRISTOPHER FRANK BOSCO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 S STATE ST
VINELAND NJ
08360-6435
US

IV. Provider business mailing address

100 OLD MARLTON PIKE W
MARLTON NJ
08053-2026
US

V. Phone/Fax

Practice location:
  • Phone: 856-692-0334
  • Fax:
Mailing address:
  • Phone: 856-596-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00531400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC007470L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: