MEDICARE: DR. CODY BRYAN BOSWELL DC

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	CH15839	FL

General Provider Information

NPI Number	:	1700733318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CODY BRYAN BOSWELL DC

Provider Business Mailing Address
First Line	:	6800 SOUTHPOINT PKWY STE 300
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-8203
Country	:	US
Telephone Number	:	623-241-8678
Fax Number	:	480-499-8459

Provider Business Practice Location Address
First Line	:	1690 US HIGHWAY 1 S STE F
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32084-6024
Country	:	US
Telephone Number	:	904-634-0640
Fax Number	:	904-634-0203

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

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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