Provider Demographics
NPI:1750707683
Name:BOATWRIGHT, WILLIAM (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BOATWRIGHT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:BO
Other - Middle Name:
Other - Last Name:BOATWRIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:6402 STEER TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6402 STEER TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1241
Practice Address - Country:US
Practice Address - Phone:512-663-8464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor