MEDICARE: DR. THADDEUS C BOSMAN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC1174	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00319931	OTHER	OH	RAILROAD MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000136035	OTHER	OH	ANTHEM PIN NUMBER
2	341657278	OTHER	OH	COMMERCIAL INSURANCE PIN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	34165727800	OTHER	OH	WORKERS' COMPENSATION PIN

General Provider Information

NPI Number	:	1215089107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THADDEUS C BOSMAN D.C.

Provider Business Mailing Address
First Line	:	8984 DARROW RD
Second Line	:
City	:	TWINSBURG
State	:	OH
Zip	:	44087-2186
Country	:	US
Telephone Number	:	330-425-2101
Fax Number	:	330-963-0478

Provider Business Practice Location Address
First Line	:	8984 DARROW RD
Second Line	:
City	:	TWINSBURG
State	:	OH
Zip	:	44087-2186
Country	:	US
Telephone Number	:	330-425-2101
Fax Number	:	330-963-0478

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/09/2007

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1396054201 — THADDEUS C. BOSMAN, D.C., INC.
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Directions to “ DR. THADDEUS C BOSMAN D.C.” Practice Location

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