Provider Demographics
NPI:1578928495
Name:DR. CRISTOPHER BOSTED, INC., P.S.
Entity Type:Organization
Organization Name:DR. CRISTOPHER BOSTED, INC., P.S.
Other - Org Name:RESTORATIVE HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTED
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:206-282-2486
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-943-4180
Mailing Address - Fax:888-431-8819
Practice Address - Street 1:1904 3RD AVE
Practice Address - Street 2:SUITE 423
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1126
Practice Address - Country:US
Practice Address - Phone:206-282-2486
Practice Address - Fax:888-431-8819
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. CRISTOPHER BOSTED, INC., P.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001147332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site