Provider Demographics
NPI:1083683585
Name:BOSKO, JASON K (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:K
Last Name:BOSKO
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 1:63 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-1511
Mailing Address - Country:US
Mailing Address - Phone:717-643-0822
Mailing Address - Fax:717-643-0953
Practice Address - Street 1:63 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-1511
Practice Address - Country:US
Practice Address - Phone:717-643-0822
Practice Address - Fax:717-643-0953
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007468L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADC007468OtherLISCENSE
PA030983WNAMedicare PIN
PADC007468OtherLISCENSE