Provider Demographics
NPI:1952637001
Name:BOFSHEVER WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:BOFSHEVER WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOFSHEVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-246-3336
Mailing Address - Street 1:4213 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3210
Mailing Address - Country:US
Mailing Address - Phone:954-246-3336
Mailing Address - Fax:954-426-0643
Practice Address - Street 1:4213 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3210
Practice Address - Country:US
Practice Address - Phone:954-246-3336
Practice Address - Fax:954-426-0643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CW957AMedicare PIN