Provider Demographics
NPI:1649366485
Name:BOOMAN CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:BOOMAN CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BOOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-498-5445
Mailing Address - Street 1:102 1ST STREET SE
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55974
Mailing Address - Country:US
Mailing Address - Phone:507-498-5445
Mailing Address - Fax:507-498-3577
Practice Address - Street 1:102 1ST STREET SE
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:MN
Practice Address - Zip Code:55974
Practice Address - Country:US
Practice Address - Phone:507-498-5445
Practice Address - Fax:507-498-3577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN06952BOOtherBCBS PROVIDER NUMBER
MN231665OtherCHIROCARE PROV NUMBER
MN231665OtherCHIROCARE PROV NUMBER