Organization
BOSSART CHIROPRACTIC LIFE CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS DAVID BOSSART DC (PRESIDENT)
(701) 239-4710
Entity
Organization
Contact information
Practice address
1815 UNIVERSITY DR S, FARGO, ND 58103-4900
(701) 239-4710
(701) 239-4719
Mailing address
1815 UNIVERSITY DR S, FARGO, ND 58103-4900
(701) 239-4710
(701) 239-4719
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
549
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01189001
BLUE CROSS BLUE SHIELD ND
ND
05
—
18215
—
ND
01
—
3C874BO
BLUE CROSS BLUE SHIELD MN
MN
01
—
549
COMMERCIAL
ND
Enumeration date
08/15/2007
Last updated
12/20/2007
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