=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225848302
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOSSERT CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2025
-----------------------------------------------------
Last Update Date | 01/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 354 EAGLE VALLEY RD
-----------------------------------------------------
City | BEECH CREEK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16822-7201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-962-3075
-----------------------------------------------------
Fax | 570-962-2573
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 495
-----------------------------------------------------
City | BEECH CREEK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16822-0495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-962-3075
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MATTHEW BOSSERT
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 570-263-0281
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------