Provider Demographics
NPI:1508942657
Name:BOSCH, KATHY J (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:J
Last Name:BOSCH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19595 VILLAGE DR
Mailing Address - Street 2:STE B
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370
Mailing Address - Country:US
Mailing Address - Phone:209-533-4330
Mailing Address - Fax:209-532-5374
Practice Address - Street 1:19515 VILLAGE DR
Practice Address - Street 2:STE B
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-9270
Practice Address - Country:US
Practice Address - Phone:209-533-4330
Practice Address - Fax:209-532-5374
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC012363111N00000X
CADC12363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor