Provider Demographics
NPI:1891138897
Name:BOVA, JOSEPH ANTHONY (DC, DACNB)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:BOVA
Suffix:
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 TROY SCHENECTADY RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1610
Mailing Address - Country:US
Mailing Address - Phone:518-608-4778
Mailing Address - Fax:
Practice Address - Street 1:960 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1610
Practice Address - Country:US
Practice Address - Phone:518-608-4778
Practice Address - Fax:618-608-6470
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX012350OtherLICENSE NUBER