Provider Demographics
NPI:1407056393
Name:BOYSON CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BOYSON CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:BOYSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-731-1133
Mailing Address - Street 1:3200 N RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-1153
Mailing Address - Country:US
Mailing Address - Phone:920-731-1133
Mailing Address - Fax:
Practice Address - Street 1:3200 N RICHMOND ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1153
Practice Address - Country:US
Practice Address - Phone:920-731-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty