Provider Demographics
NPI:1710186937
Name:BOZMAN, GERARD ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:ANTHONY
Last Name:BOZMAN
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 1:10956 SANTORINI DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141
Mailing Address - Country:US
Mailing Address - Phone:702-269-1540
Mailing Address - Fax:702-269-9215
Practice Address - Street 1:8050 DEAN MARTIN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139
Practice Address - Country:US
Practice Address - Phone:702-269-1540
Practice Address - Fax:702-269-9215
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor