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General NPI Number Information
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NPI Number | 1396840070
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Entity Type | Individual
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Provider Name | MICHAEL BOSLEY DC
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 11/20/2019
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Provider Practice Location Address
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Address Line | 7388 CARNELIAN ST STE A
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1160
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Country | US
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Telephone | 909-945-5072
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Fax |
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Provider Business Mailing Address
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Address Line | 12392 LILY CT
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-1656
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Country | US
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Telephone | 909-938-6113
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DC-30293
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License Number State | CA
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