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General NPI Number Information
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NPI Number | 1245508035
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Entity Type | Organization
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Legal Business Name | BOSCO CHIROPRACTIC CLINIC PC
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 127 E PARK AVE
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-2801
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Country | US
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Telephone | 847-680-3138
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Fax | 841-680-5889
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Provider Business Mailing Address
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Address Line | 127 E PARK AVE
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-2801
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Country | US
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Telephone | 847-680-3138
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Fax | 847-680-5889
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Authorized Official
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Title or Position | OWNER
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Name | DR. DINO G BOSCO
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Credential | D.C.
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Telephone | 847-680-3138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038007827
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License Number State | IL
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