Provider Demographics
NPI:1760707772
Name:BOSCH, JOHN ROLLIN (DC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROLLIN
Last Name:BOSCH
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:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:SD
Mailing Address - Zip Code:57058-0059
Mailing Address - Country:US
Mailing Address - Phone:605-425-2754
Mailing Address - Fax:605-425-2759
Practice Address - Street 1:221 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:SD
Practice Address - Zip Code:57058-8540
Practice Address - Country:US
Practice Address - Phone:605-425-2754
Practice Address - Fax:605-425-2759
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor