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Individual

DR. KENNETH L. BOSARGE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
7302D HIGHWAY 613, MOSS POINT, MS 39563-9312
(228) 475-6437
(228) 474-1325
Mailing address
PO BOX 2028, ESCATAWPA, MS 39552-2028
(228) 475-6437
(228) 474-1325

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
867
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5598580
AETNA
MS
Enumeration date
10/04/2006
Last updated
07/08/2007
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