Provider Demographics
NPI:1639467459
Name:BOARDMAN, DANA ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:ANTHONY
Last Name:BOARDMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:LAGUNITAS
Mailing Address - State:CA
Mailing Address - Zip Code:94938-0024
Mailing Address - Country:US
Mailing Address - Phone:415-488-4300
Mailing Address - Fax:
Practice Address - Street 1:7282 SIR FRANCIS DRAKE BLVD.
Practice Address - Street 2:SUITE B
Practice Address - City:LAGUNITAS
Practice Address - State:CA
Practice Address - Zip Code:94938
Practice Address - Country:US
Practice Address - Phone:415-488-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor