Healthcare Provider Details

I. General information

NPI: 1003066507
Provider Name (Legal Business Name): MICHAEL JOHN BOSTJANCIC D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MIKE JOHN BOSTJANCIC D.C

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 RIVERWALK BLVD STE 3C
RIDGELAND SC
29936-3201
US

IV. Provider business mailing address

51 RIVERWALK BLVD STE 3C
RIDGELAND SC
29936-3201
US

V. Phone/Fax

Practice location:
  • Phone: 843-252-0533
  • Fax: 843-510-1122
Mailing address:
  • Phone: 843-252-0533
  • Fax: 843-510-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH60036331
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: