Provider Demographics
NPI:1639268964
Name:BOST, EDWIN HEATHMAN IV (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:HEATHMAN
Last Name:BOST
Suffix:IV
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 1:3 BARTLES CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-5363
Mailing Address - Country:US
Mailing Address - Phone:864-967-0039
Mailing Address - Fax:
Practice Address - Street 1:7 FIVE FORK PLAZA CT STE D
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-5461
Practice Address - Country:US
Practice Address - Phone:864-458-7008
Practice Address - Fax:864-458-7002
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor