Provider Demographics
NPI:1942598727
Name:BOSTROM, BJORN (DC)
Entity Type:Individual
Prefix:
First Name:BJORN
Middle Name:
Last Name:BOSTROM
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 1:149 JOSEPHINE ST STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2775
Mailing Address - Country:US
Mailing Address - Phone:831-459-8434
Mailing Address - Fax:831-459-8434
Practice Address - Street 1:149 JOSEPHINE ST STE A
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2775
Practice Address - Country:US
Practice Address - Phone:831-459-8434
Practice Address - Fax:831-459-8434
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor