Provider Demographics
NPI:1366736308
Name:BOSWELL, ANDREW WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WILLIAM
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 1:1614 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-8603
Mailing Address - Country:US
Mailing Address - Phone:309-786-1700
Mailing Address - Fax:
Practice Address - Street 1:1614 2ND AVE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-8603
Practice Address - Country:US
Practice Address - Phone:309-786-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011948111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor