Provider Demographics
NPI:1801950100
Name:BOST CHIROPRACTIC CLINIC, P.A.
Entity type:Organization
Organization Name:BOST CHIROPRACTIC CLINIC, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:O
Authorized Official - Last Name:BOST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-638-0165
Mailing Address - Street 1:1035 LINCOLNTON RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-6277
Mailing Address - Country:US
Mailing Address - Phone:704-638-0165
Mailing Address - Fax:704-633-5962
Practice Address - Street 1:1035 LINCOLNTON RD
Practice Address - Street 2:SUITE D
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-6277
Practice Address - Country:US
Practice Address - Phone:704-638-0165
Practice Address - Fax:704-633-5962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908248Medicaid
NCT64451Medicare UPIN
NC244409Medicare ID - Type Unspecified