Provider Demographics
NPI:1215108162
Name:BOSARGE FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:BOSARGE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:REJINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOSARGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:228-475-6437
Mailing Address - Street 1:PO BOX 2028
Mailing Address - Street 2:
Mailing Address - City:ESCATAWPA
Mailing Address - State:MS
Mailing Address - Zip Code:39552-2028
Mailing Address - Country:US
Mailing Address - Phone:228-475-6437
Mailing Address - Fax:228-474-1325
Practice Address - Street 1:7302D HIGHWAY 613
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39563-9312
Practice Address - Country:US
Practice Address - Phone:228-475-6437
Practice Address - Fax:228-474-1325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS34300Medicare UPIN