Provider Demographics
NPI:1063943892
Name:JUSTIN BOYCE, P.C.
Entity type:Organization
Organization Name:JUSTIN BOYCE, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-308-4585
Mailing Address - Street 1:114 W CALENDAR AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2601
Mailing Address - Country:US
Mailing Address - Phone:708-308-4585
Mailing Address - Fax:
Practice Address - Street 1:114 W CALENDAR AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2601
Practice Address - Country:US
Practice Address - Phone:708-308-4585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUSTIN BOYCE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010051111N00000X
IL038-010420111NP0017X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty