Provider Demographics
NPI:1962431221
Name:BOST, HAROLD CLIFFORD JR (DC)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:CLIFFORD
Last Name:BOST
Suffix:JR
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 1:1117 CROSSTOWN CT
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-2951
Mailing Address - Country:US
Mailing Address - Phone:770-631-3822
Mailing Address - Fax:770-486-3515
Practice Address - Street 1:1117 CROSSTOWN CT
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-2951
Practice Address - Country:US
Practice Address - Phone:770-631-3822
Practice Address - Fax:770-486-3515
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA04673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor