Provider Demographics
NPI:1669589883
Name:CLEVELAND-BOSTEN, MICHELE DOREEN (DC)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:DOREEN
Last Name:CLEVELAND-BOSTEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3283 MOTOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034
Mailing Address - Country:US
Mailing Address - Phone:310-559-6900
Mailing Address - Fax:310-836-8664
Practice Address - Street 1:3283 MOTOR AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034
Practice Address - Country:US
Practice Address - Phone:310-559-6900
Practice Address - Fax:310-836-8664
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17611AOtherWDC
CA17611AOtherWDC
T18577Medicare UPIN
CAW18155Medicare ID - Type Unspecified