Provider Demographics
NPI:1265625073
Name:BOARDMAN FAMILY CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:BOARDMAN FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOARDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-704-1954
Mailing Address - Street 1:10235 S 51ST ST
Mailing Address - Street 2:#170
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5218
Mailing Address - Country:US
Mailing Address - Phone:480-704-1954
Mailing Address - Fax:480-704-1663
Practice Address - Street 1:10235 S 51ST ST
Practice Address - Street 2:#170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5218
Practice Address - Country:US
Practice Address - Phone:480-704-1954
Practice Address - Fax:480-704-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDE5137OtherRR MEDICARE
AZDE5137OtherRR MEDICARE
AZ6198220001Medicare NSC