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General NPI Number Information
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NPI Number | 1063782183
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Entity Type | Organization
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Legal Business Name | KATHY BOSCH CHIROPRACTIC, INC
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Dates
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Enumeration Date | 01/05/2012
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Last Update Date | 01/05/2012
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Provider Practice Location Address
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Address Line | 19515 VILLAGE DR STE B
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City | SONORA
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State | CA
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Zip | 95370-9586
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Country | US
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Telephone | 209-533-4330
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Fax | 509-532-5374
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Provider Business Mailing Address
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Address Line | 19515 VILLAGE DR STE B
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City | SONORA
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State | CA
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Zip | 95370-9586
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Country | US
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Telephone | 209-533-4330
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Fax | 509-532-5374
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KATHY J BOSCH
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Credential | DC
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Telephone | 209-533-4330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | DC012363
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License Number State | CA
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