Healthcare Provider Details

I. General information

NPI: 1740192335
Provider Name (Legal Business Name): JOSEPH VANDERBOSCH CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 W CHARLOTTE ST
RIVER FALLS WI
54022-2847
US

IV. Provider business mailing address

366 W CHARLOTTE ST
RIVER FALLS WI
54022-2847
US

V. Phone/Fax

Practice location:
  • Phone: 651-908-8791
  • Fax:
Mailing address:
  • Phone: 651-908-8791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: