Provider Demographics
NPI:1225848302
Name:BOSSERT CHIROPRACTIC
Entity type:Organization
Organization Name:BOSSERT CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSSERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-263-0281
Mailing Address - Street 1:PO BOX 495
Mailing Address - Street 2:
Mailing Address - City:BEECH CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:16822-0495
Mailing Address - Country:US
Mailing Address - Phone:570-962-3075
Mailing Address - Fax:
Practice Address - Street 1:354 EAGLE VALLEY RD
Practice Address - Street 2:
Practice Address - City:BEECH CREEK
Practice Address - State:PA
Practice Address - Zip Code:16822-7201
Practice Address - Country:US
Practice Address - Phone:570-962-3075
Practice Address - Fax:570-962-2573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty