Provider Demographics
NPI:1881690428
Name:BOFSHEVER, HARLEY J (DC)
Entity type:Individual
Prefix:
First Name:HARLEY
Middle Name:J
Last Name:BOFSHEVER
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 1:4213 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3210
Mailing Address - Country:US
Mailing Address - Phone:954-246-3336
Mailing Address - Fax:954-426-0643
Practice Address - Street 1:4213 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3210
Practice Address - Country:US
Practice Address - Phone:954-246-3336
Practice Address - Fax:954-426-0643
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380766500Medicaid
FL55245OtherFLORIDA BLUE
FL55245OtherFLORIDA BLUE
U54976Medicare UPIN