Provider Demographics
NPI:1568735017
Name:BOULEVARD FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BOULEVARD FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:LINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-249-6973
Mailing Address - Street 1:201 SW PORT ST LUCIE BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5023
Mailing Address - Country:US
Mailing Address - Phone:772-249-6973
Mailing Address - Fax:
Practice Address - Street 1:201 SW PORT ST LUCIE BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5023
Practice Address - Country:US
Practice Address - Phone:772-249-6973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty