Provider Demographics
NPI:1700217692
Name:JOSEPH A BOVA CHIROPRACTOR PC
Entity Type:Organization
Organization Name:JOSEPH A BOVA CHIROPRACTOR PC
Other - Org Name:BOVA HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-608-4778
Mailing Address - Street 1:1182 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1182 TROY SCHENECTADY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1000
Practice Address - Country:US
Practice Address - Phone:518-608-4778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty