Provider Demographics
NPI:1023745882
Name:BOAZ CHIROPRACTIC
Entity type:Organization
Organization Name:BOAZ CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:T
Authorized Official - Last Name:HATALA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-840-5558
Mailing Address - Street 1:419 US HIGHWAY 431
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-2183
Mailing Address - Country:US
Mailing Address - Phone:256-840-5558
Mailing Address - Fax:256-298-5085
Practice Address - Street 1:419 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-2183
Practice Address - Country:US
Practice Address - Phone:256-840-5558
Practice Address - Fax:256-298-5085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1874OtherLICENSE