Provider Demographics
NPI:1750859351
Name:BOMBERY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BOMBERY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMBERY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-910-5880
Mailing Address - Street 1:17 WHITE OAK BLF
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-8109
Mailing Address - Country:US
Mailing Address - Phone:908-910-5880
Mailing Address - Fax:
Practice Address - Street 1:122 CANAL ST. STE 109
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322
Practice Address - Country:US
Practice Address - Phone:908-910-5880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty