Provider Demographics
NPI:1124159884
Name:BOSWELL, JOE L (DC)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:L
Last Name:BOSWELL
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 1:1010A E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2308
Mailing Address - Country:US
Mailing Address - Phone:601-656-8710
Mailing Address - Fax:601-389-0760
Practice Address - Street 1:1010A E MAIN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2308
Practice Address - Country:US
Practice Address - Phone:601-656-8710
Practice Address - Fax:601-389-0760
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor