Provider Demographics
NPI:1295865913
Name:BOZEMAN, RICHARD WAYNE JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WAYNE
Last Name:BOZEMAN
Suffix:JR
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 1:4808 S BUCKNER BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-2348
Mailing Address - Country:US
Mailing Address - Phone:214-388-4808
Mailing Address - Fax:214-388-4100
Practice Address - Street 1:4808 S BUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-2348
Practice Address - Country:US
Practice Address - Phone:214-388-4808
Practice Address - Fax:214-388-4100
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor