Provider Demographics
NPI:1659420537
Name:BOOTS CHIROPRACTIC AND WELLNESS CENTER, S.C.
Entity Type:Organization
Organization Name:BOOTS CHIROPRACTIC AND WELLNESS CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BOOTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-997-9700
Mailing Address - Street 1:1020 TRUMAN ST STE B
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:WI
Mailing Address - Zip Code:54136-2211
Mailing Address - Country:US
Mailing Address - Phone:920-997-9700
Mailing Address - Fax:920-997-0060
Practice Address - Street 1:1020 TRUMAN ST STE B
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:WI
Practice Address - Zip Code:54136-2211
Practice Address - Country:US
Practice Address - Phone:920-997-9700
Practice Address - Fax:920-997-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2055-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty