Provider Demographics
NPI:1215089107
Name:BOSMAN, THADDEUS C (DC)
Entity type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:C
Last Name:BOSMAN
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 1:8984 DARROW RD
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2186
Mailing Address - Country:US
Mailing Address - Phone:330-425-2101
Mailing Address - Fax:330-963-0478
Practice Address - Street 1:8984 DARROW RD
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2186
Practice Address - Country:US
Practice Address - Phone:330-425-2101
Practice Address - Fax:330-963-0478
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC1174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000136035OtherANTHEM PIN NUMBER
OH341657278OtherCOMMERCIAL INSURANCE PIN
OHP00319931OtherRAILROAD MEDICARE PIN
OH0655643Medicaid
OH34165727800OtherWORKERS' COMPENSATION PIN
OH341657278OtherCOMMERCIAL INSURANCE PIN