Provider Demographics
NPI:1417215443
Name:CONNIE BOCZARSKI DC, PA
Entity Type:Organization
Organization Name:CONNIE BOCZARSKI DC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOCZARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-330-9004
Mailing Address - Street 1:7601 N FEDERAL HWY
Mailing Address - Street 2:150A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1657
Mailing Address - Country:US
Mailing Address - Phone:561-330-9004
Mailing Address - Fax:561-330-9006
Practice Address - Street 1:7601 N FEDERAL HWY
Practice Address - Street 2:150A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1657
Practice Address - Country:US
Practice Address - Phone:561-330-9004
Practice Address - Fax:561-330-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty