Provider Demographics
NPI:1467417675
Name:BOU, ROSEMARIE (DC)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:BOU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ROSEMARIE
Other - Middle Name:
Other - Last Name:EICHHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:242 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001
Mailing Address - Country:US
Mailing Address - Phone:516-328-9015
Mailing Address - Fax:516-488-9865
Practice Address - Street 1:242 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001
Practice Address - Country:US
Practice Address - Phone:516-328-9015
Practice Address - Fax:516-488-9865
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX59621Medicare ID - Type Unspecified
U42089Medicare UPIN