Provider Demographics
NPI:1205944899
Name:STOJANOVICH, BOSHIDAR (DC)
Entity type:Individual
Prefix:DR
First Name:BOSHIDAR
Middle Name:
Last Name:STOJANOVICH
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 1:411 MT SEQUOIA CT
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:CA
Mailing Address - Zip Code:94517-1611
Mailing Address - Country:US
Mailing Address - Phone:925-672-2889
Mailing Address - Fax:925-930-0412
Practice Address - Street 1:1229 OAKLAND BLVD STE A
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4359
Practice Address - Country:US
Practice Address - Phone:925-930-0224
Practice Address - Fax:925-930-0412
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT05819Medicare UPIN
CADC0155651Medicare ID - Type Unspecified