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General NPI Number Information
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NPI Number | 1487608162
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Entity Type | Organization
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Legal Business Name | BOSMAN CHIROPRACTIC LIFE CENTER, P.C.
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 09/10/2012
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Provider Practice Location Address
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Address Line | 709 S OPDYKE RD
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City | AUBURN HILLS
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State | MI
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Zip | 48326-3436
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Country | US
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Telephone | 248-253-1700
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Fax | 248-253-1707
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Provider Business Mailing Address
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Address Line | 709 S OPDYKE RD
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City | AUBURN HILLS
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State | MI
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Zip | 48326-3436
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Country | US
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Telephone | 248-253-1700
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Fax | 248-253-1707
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEFFREY JOSEPH BOSMAN
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Credential | D.C.
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Telephone | 248-253-1700
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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 | 2301007418
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License Number State | MI
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