Provider Demographics
NPI:1760684021
Name:BOERNE WELLNESS CHIROPRACTIC, P. A.
Entity Type:Organization
Organization Name:BOERNE WELLNESS CHIROPRACTIC, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:BOERNE
Authorized Official - Middle Name:WELLNESS
Authorized Official - Last Name:CHIROPRACTIC, P. A.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-249-8900
Mailing Address - Street 1:215 W. BANDERA
Mailing Address - Street 2:SUITE 114, PMB 406
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-9998
Mailing Address - Country:US
Mailing Address - Phone:830-249-8900
Mailing Address - Fax:830-249-8923
Practice Address - Street 1:115 HWY 46 W
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9998
Practice Address - Country:US
Practice Address - Phone:830-249-8900
Practice Address - Fax:830-249-8923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00496WMedicare PIN
TXP00315750Medicare PIN