=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841961562
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOSLER LONGEVITY HEALTH & CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2021
-----------------------------------------------------
Last Update Date | 09/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 203 29TH ST APT B
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92663-3456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-891-1663
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3419 VIA LIDO # 326
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92663-3908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-891-1663
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CHRISTOPHER LEE BOSLER
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 949-891-1663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------