Provider Demographics
NPI:1023068749
Name:BOSHOFF, LYNETTE (DC)
Entity type:Individual
Prefix:DR
First Name:LYNETTE
Middle Name:
Last Name:BOSHOFF
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:LYNETTE
Other - Middle Name:
Other - Last Name:DE LANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:890 ELM GROVE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2528
Mailing Address - Country:US
Mailing Address - Phone:414-617-0909
Mailing Address - Fax:
Practice Address - Street 1:890 ELM GROVE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2528
Practice Address - Country:US
Practice Address - Phone:414-617-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3869-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor