Provider Demographics
NPI:1184894594
Name:BOERBOOM, NICOLE KRISTINE (DC)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:KRISTINE
Last Name:BOERBOOM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W QUEEN CREEK RD
Mailing Address - Street 2:#2
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-3001
Mailing Address - Country:US
Mailing Address - Phone:630-660-4436
Mailing Address - Fax:
Practice Address - Street 1:1801 W QUEEN CREEK RD
Practice Address - Street 2:#2
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-3001
Practice Address - Country:US
Practice Address - Phone:630-660-4436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011011111N00000X
AZ8104111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor