Provider Demographics
NPI:1063782183
Name:KATHY BOSCH CHIROPRACTIC, INC
Entity type:Organization
Organization Name:KATHY BOSCH CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-533-4330
Mailing Address - Street 1:19515 VILLAGE DR
Mailing Address - Street 2:STE B
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9586
Mailing Address - Country:US
Mailing Address - Phone:209-533-4330
Mailing Address - Fax:509-532-5374
Practice Address - Street 1:19515 VILLAGE DR
Practice Address - Street 2:STE B
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-9586
Practice Address - Country:US
Practice Address - Phone:209-533-4330
Practice Address - Fax:509-532-5374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC012363261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC012363Medicare UPIN