Provider Demographics
NPI:1184305385
Name:BOSS, PAUL PATRICK JR (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:PATRICK
Last Name:BOSS
Suffix:JR
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 1:500 SE DIXIE HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3054
Mailing Address - Country:US
Mailing Address - Phone:772-223-9777
Mailing Address - Fax:
Practice Address - Street 1:500 SE DIXIE HWY STE 2
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3054
Practice Address - Country:US
Practice Address - Phone:772-223-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14632111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor