Provider Demographics
NPI:1215945597
Name:BOCZAR, DAVID THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THOMAS
Last Name:BOCZAR
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 1:92 VILLAGE AT GLYNN PL
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-1993
Mailing Address - Country:US
Mailing Address - Phone:912-264-1806
Mailing Address - Fax:912-264-1808
Practice Address - Street 1:92 VILLAGE AT GLYNN PL
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-1993
Practice Address - Country:US
Practice Address - Phone:912-264-1806
Practice Address - Fax:912-264-1808
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO07228111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU89959Medicare UPIN