Provider Demographics
NPI:1376813626
Name:BOZE FAMILY CHIROPRACTIC AND WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:BOZE FAMILY CHIROPRACTIC AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOZE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-610-9991
Mailing Address - Street 1:495 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5680
Mailing Address - Country:US
Mailing Address - Phone:352-610-9991
Mailing Address - Fax:352-610-9992
Practice Address - Street 1:495 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5680
Practice Address - Country:US
Practice Address - Phone:352-610-9991
Practice Address - Fax:352-610-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10210111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty