Provider Demographics
NPI:1093996878
Name:J. JEFFREY BOS, D.C., P.A.
Entity Type:Organization
Organization Name:J. JEFFREY BOS, D.C., P.A.
Other - Org Name:TUSCAWILLA CHIROPRACTIC CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:BOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-695-3000
Mailing Address - Street 1:1450 TUSKAWILLA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5204
Mailing Address - Country:US
Mailing Address - Phone:407-695-3000
Mailing Address - Fax:407-695-3888
Practice Address - Street 1:1450 TUSKAWILLA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5204
Practice Address - Country:US
Practice Address - Phone:407-695-3000
Practice Address - Fax:407-695-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55534AMedicare PIN