Provider Demographics
NPI:1821299215
Name:BOS, WILLEM E (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLEM
Middle Name:E
Last Name:BOS
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 1:200 N CHIPPEWA PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4307
Mailing Address - Country:US
Mailing Address - Phone:480-732-1000
Mailing Address - Fax:480-732-1202
Practice Address - Street 1:200 N CHIPPEWA PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4307
Practice Address - Country:US
Practice Address - Phone:480-732-1000
Practice Address - Fax:480-732-1202
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07667595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0939730OtherBCBS
AZZ72448Medicare PIN
AZU77808Medicare UPIN