Healthcare Provider Details

I. General information

NPI: 1760707772
Provider Name (Legal Business Name): JOHN ROLLIN BOSCH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 S MAIN ST
SALEM SD
57058-8540
US

IV. Provider business mailing address

PO BOX 59
SALEM SD
57058-0059
US

V. Phone/Fax

Practice location:
  • Phone: 605-425-2754
  • Fax: 605-425-2759
Mailing address:
  • Phone: 605-425-2754
  • Fax: 605-425-2759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1184
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: