Provider Demographics
NPI:1376745927
Name:BOUSTEAD, JOHN PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:BOUSTEAD
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 1:1813 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-1707
Mailing Address - Country:US
Mailing Address - Phone:412-384-3523
Mailing Address - Fax:412-384-3523
Practice Address - Street 1:1813 E CARSON ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-1707
Practice Address - Country:US
Practice Address - Phone:412-384-3523
Practice Address - Fax:412-384-3523
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011287111NN0400X
PADC009912111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology