Provider Demographics
NPI:1083898746
Name:JAMES C BOYSEN, DC, PC
Entity Type:Organization
Organization Name:JAMES C BOYSEN, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOYSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PC
Authorized Official - Phone:563-259-9411
Mailing Address - Street 1:1732 S WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMANCHE
Mailing Address - State:IA
Mailing Address - Zip Code:52730-1713
Mailing Address - Country:US
Mailing Address - Phone:563-259-9411
Mailing Address - Fax:
Practice Address - Street 1:1732 S WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CAMANCHE
Practice Address - State:IA
Practice Address - Zip Code:52730-1713
Practice Address - Country:US
Practice Address - Phone:563-259-9411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5923111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA249088OtherMIDLAND'S
IA1449686Medicaid
IA52781OtherWELLMARK
IA216156OtherOTHER
IA52781OtherWELLMARK
IA216156OtherOTHER