Provider Demographics
NPI:1003066507
Name:BOSTJANCIC, MICHAEL JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:BOSTJANCIC
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:MIKE
Other - Middle Name:JOHN
Other - Last Name:BOSTJANCIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:10700 SE 208TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-5545
Mailing Address - Country:US
Mailing Address - Phone:253-854-3185
Mailing Address - Fax:253-852-9210
Practice Address - Street 1:10700 SE 208TH ST STE 207
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-5545
Practice Address - Country:US
Practice Address - Phone:253-854-3185
Practice Address - Fax:253-852-9210
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60036331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor