Justin Bosten, BCSI, LMT

Individual provider Active NPI Massage Therapist · Ishpeming, MI

NPI 1689457764 · NPPES record last updated Aug 14, 2023

Key facts

NPI
1689457764
Entity type
Individual (NPI type 1)
Primary specialty
Massage Therapist 225700000X
License
7501014794 (MI)
Practice address
1000 Country LN Ste 400
Ishpeming, MI 49849-3410
Phone
(906) 486-2000
NPI assigned
Aug 14, 2023
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
7501014794MIMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
J P Lasich Chiropractic, LLC Past
since Aug 27, 2023
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 7501014794 MI Yes

Addresses

Primary practice location

1000 Country LN Ste 400
Ishpeming, MI 49849-3410

Mailing address

7275 County Road 550
Marquette, MI 49855-9766
Phone (906) 362-3878

Other providers in Ishpeming, MI

All providers in Ishpeming, MI · Massage Therapist in Michigan

Sources for this page

Verify at the official NPI Registry.