Provider Demographics
NPI:1467471714
Name:BOSSART, THOMAS DAVID (DC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:DAVID
Last Name:BOSSART
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 1:1815 UNIVERSITY DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4900
Mailing Address - Country:US
Mailing Address - Phone:701-239-4710
Mailing Address - Fax:701-239-4719
Practice Address - Street 1:1815 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4900
Practice Address - Country:US
Practice Address - Phone:701-239-4710
Practice Address - Fax:701-239-4719
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND01189001OtherBLUE CROSS BLUE SHIELD ND
ND18215Medicaid
MN3C874BOOtherBLUE CROSS BLUE SHIELD MN
ND549OtherCOMMERCIAL
ND01189001OtherBLUE CROSS BLUE SHIELD ND
ND18215Medicaid