Provider Demographics
NPI:1376865741
Name:BOSTON CHIROPRACTIC
Entity Type:Organization
Organization Name:BOSTON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:BRETT
Authorized Official - Last Name:VANOSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-765-8443
Mailing Address - Street 1:2630 26TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-2220
Mailing Address - Country:US
Mailing Address - Phone:806-765-8443
Mailing Address - Fax:806-749-1181
Practice Address - Street 1:2630 26TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2220
Practice Address - Country:US
Practice Address - Phone:806-765-8443
Practice Address - Fax:806-749-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty