Provider Demographics
NPI:1982775847
Name:BOON, BEVERLY ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:ELIZABETH
Last Name:BOON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:813 FORREST DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4513
Mailing Address - Country:US
Mailing Address - Phone:757-596-7605
Mailing Address - Fax:757-596-5789
Practice Address - Street 1:813 FORREST DR
Practice Address - Street 2:SUITE 4
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4513
Practice Address - Country:US
Practice Address - Phone:757-596-7605
Practice Address - Fax:757-596-5789
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000522111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor