Provider Demographics
NPI:1285829606
Name:BOZICEVIC, ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:BOZICEVIC
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 1:2058 S DOBSON RD STE 4
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6455
Mailing Address - Country:US
Mailing Address - Phone:480-820-1818
Mailing Address - Fax:480-756-2309
Practice Address - Street 1:2058 S DOBSON RD STE 4
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6455
Practice Address - Country:US
Practice Address - Phone:480-820-1818
Practice Address - Fax:480-756-2309
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ20683Medicare PIN