Provider Demographics
NPI:1396054201
Name:THADDEUS C. BOSMAN, D.C., INC.
Entity type:Organization
Organization Name:THADDEUS C. BOSMAN, D.C., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THADDEUS
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-425-2101
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH362823184002OtherMEDICAL MUTUAL PIN NUMBER
OH000000136035OtherANTHEM PIN NUMBER
OH0655643Medicaid
OHP00319931OtherRAILROAD MEDICARE PIN
OH362823184002OtherMEDICAL MUTUAL PIN NUMBER
OH=========00OtherOHIO BUREAU OF WORKERS' COMPENSATION
OH=========OtherCOMMERCIAL INSURANCE PIN