Provider Demographics
NPI:1013212539
Name:BOSSIO, GEOFFREY EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:EDWARD
Last Name:BOSSIO
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 1:519 BLOOMFIELD AVE
Mailing Address - Street 2:STE L21
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5510
Mailing Address - Country:US
Mailing Address - Phone:203-838-9795
Mailing Address - Fax:203-853-2078
Practice Address - Street 1:519 BLOOMFIELD AVE STE L21
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5510
Practice Address - Country:US
Practice Address - Phone:973-228-8600
Practice Address - Fax:973-228-8600
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor