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General NPI Number Information
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NPI Number | 1700217692
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Entity Type | Organization
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Legal Business Name | JOSEPH A BOVA CHIROPRACTOR PC
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 1182 TROY SCHENECTADY RD SUITE 202
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City | LATHAM
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State | NY
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Zip | 12110-1000
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Country | US
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Telephone | 518-608-4778
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Fax |
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Provider Business Mailing Address
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Address Line | 1182 TROY SCHENECTADY RD SUITE 202
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City | LATHAM
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State | NY
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Zip | 12110-1000
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH ANTHONY BOVA
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Credential | D.C
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Telephone | 518-608-4778
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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 | X012350
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License Number State | NY
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