Provider Demographics
NPI:1659514834
Name:BOFSHEVER, GENA M (DC)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:M
Last Name:BOFSHEVER
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 1:7119 W BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2210
Mailing Address - Country:US
Mailing Address - Phone:954-417-5815
Mailing Address - Fax:
Practice Address - Street 1:7119 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2210
Practice Address - Country:US
Practice Address - Phone:954-417-5815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010076111N00000X
FLCH10470111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor