Provider Demographics
NPI:1265755227
Name:BANDY, BOAZ LEE (DC)
Entity type:Individual
Prefix:DR
First Name:BOAZ
Middle Name:LEE
Last Name:BANDY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 STATE HIGHWAY 248
Mailing Address - Street 2:SUITE 2-B
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-3721
Mailing Address - Country:US
Mailing Address - Phone:417-337-7077
Mailing Address - Fax:
Practice Address - Street 1:800 STATE HIGHWAY 248
Practice Address - Street 2:SUITE 2-B
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-3721
Practice Address - Country:US
Practice Address - Phone:417-337-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009032450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor