Provider Demographics
NPI:1104260165
Name:BOZIAN, GARY STEPAN (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:STEPAN
Last Name:BOZIAN
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 1:17 ACADEMY ST
Mailing Address - Street 2:SUITE 602
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2923
Mailing Address - Country:US
Mailing Address - Phone:973-824-2225
Mailing Address - Fax:973-824-5454
Practice Address - Street 1:17 ACADEMY ST
Practice Address - Street 2:SUITE 602
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2923
Practice Address - Country:US
Practice Address - Phone:973-824-2225
Practice Address - Fax:973-824-5454
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03260111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation