Active NPI
Kenneth L. Bosarge, D.C.
- Chiropractor
- Moss Point, MS
National Provider Identifier
1568557296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 867
- Practice address
- 7302D Highway 613
Moss Point, MS 39563-9312 - Phone
- (228) 475-6437
- Fax
- (228) 474-1325
- NPI assigned
- Oct 4, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 867 | MS | Primary |
Addresses
Primary practice location
7302D Highway 613
Moss Point, MS 39563-9312
Mailing address
PO Box 2028
Escatawpa, MS 39552-2028
Phone (228) 475-6437
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5598580 | Other | MS | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 867 | MS | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1568557296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2028",
"city": "ESCATAWPA",
"state": "MS",
"postal_code": "395522028",
"telephone_number": "228-475-6437",
"fax_number": "228-474-1325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7302D HIGHWAY 613",
"city": "MOSS POINT",
"state": "MS",
"postal_code": "395639312",
"telephone_number": "228-475-6437",
"fax_number": "228-474-1325"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOSARGE",
"first_name": "KENNETH",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MS",
"license": "867",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5598580",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moss Point, MS
- Harris G. Barrett, M.D.
- Elizabeth Adair Beatty, PHARM.D.
- Behavioral Health Programs
- Bonita Health Care Services
- Bosarge Family Chiropractic
- Brackish Counseling & Psychotherapy LLC
- Tiffany Broughton
- Lauren Quinn Brown I, PTA
- Burnham McKinney Pharmacies Inc (Burnhams Vital Care)
- Burnham McKinney Pharmacies Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.