Provider Demographics
NPI:1558425348
Name:BOSCHER, KENNETH FRANK (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:FRANK
Last Name:BOSCHER
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 1:2365 WALL ST SE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2197
Mailing Address - Country:US
Mailing Address - Phone:770-922-8187
Mailing Address - Fax:770-922-9107
Practice Address - Street 1:2365 WALL ST SE STE 120
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2197
Practice Address - Country:US
Practice Address - Phone:770-922-8187
Practice Address - Fax:770-922-9107
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1194100370OtherGROUP NPI
GAU54937Medicare UPIN