Provider Demographics
NPI:1356374169
Name:BOOS, PHILIP H (DC)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:H
Last Name:BOOS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 ROUTE 10 E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1300
Mailing Address - Country:US
Mailing Address - Phone:973-584-8677
Mailing Address - Fax:973-584-7662
Practice Address - Street 1:225 ROUTE 10 E
Practice Address - Street 2:SUITE 101
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1300
Practice Address - Country:US
Practice Address - Phone:973-584-8677
Practice Address - Fax:973-584-7662
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00193300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000179199OtherHIGHMARK BLUE SHIELD
933999OtherAETNA
P408111OtherOXFORD
0090002000OtherAMERI HEALTH
148566OtherUNITED HEALTHCARE
NJ179199Medicare ID - Type Unspecified
0090002000OtherAMERI HEALTH