Provider Demographics
NPI:1215089834
Name:BOS, JOHN JEFFREY (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JEFFREY
Last Name:BOS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1425 TUSKAWILLA ROAD
Mailing Address - Street 2:SUITE 153
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5204
Mailing Address - Country:US
Mailing Address - Phone:407-695-3000
Mailing Address - Fax:407-695-3888
Practice Address - Street 1:1425 TUSKAWILLA RD
Practice Address - Street 2:SUITE 153
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5289
Practice Address - Country:US
Practice Address - Phone:407-695-3000
Practice Address - Fax:407-695-3888
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006738111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55534OtherBCBS
FL55534OtherBCBS