Provider Demographics
NPI:1629093315
Name:BOSTOCK, GUY M (DC)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:M
Last Name:BOSTOCK
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 1:7881 CHURCH ST
Mailing Address - Street 2:A
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-5141
Mailing Address - Country:US
Mailing Address - Phone:408-847-7246
Mailing Address - Fax:408-847-5577
Practice Address - Street 1:7881 CHURCH ST
Practice Address - Street 2:A
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-5141
Practice Address - Country:US
Practice Address - Phone:408-847-7246
Practice Address - Fax:408-847-5577
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0226010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0226010Medicare UPIN