Provider Demographics
NPI:1245217330
Name:BOSMAN, JEFFREY J (DC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:J
Last Name:BOSMAN
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 1:709 S OPDYKE RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3436
Mailing Address - Country:US
Mailing Address - Phone:248-253-1700
Mailing Address - Fax:248-253-1707
Practice Address - Street 1:709 S OPDYKE RD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-3436
Practice Address - Country:US
Practice Address - Phone:248-253-1700
Practice Address - Fax:248-253-1707
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4375884Medicaid
MI0N39990Medicare ID - Type Unspecified
MI0P32460Medicare PIN