MEDICARE: DR. JEFFREY BOVA 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	X047881	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8890027	OTHER	NY	INDEPENDENT HEALTH
2	00020629005	OTHER	NY	BC/BS
3	5898019	OTHER	NY	GHI
4	161354798	OTHER	NY	AETNA
5	C04788-8	OTHER	NY	WCB

General Provider Information

NPI Number	:	1750498655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY BOVA D.C.

Provider Business Mailing Address
First Line	:	1953 RIDGE RD
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-3339
Country	:	US
Telephone Number	:	716-675-4134
Fax Number	:	716-675-5733

Provider Business Practice Location Address
First Line	:	1953 RIDGE RD
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-3339
Country	:	US
Telephone Number	:	716-675-4134
Fax Number	:	716-675-5733

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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