Provider Demographics
NPI:1215596879
Name:BOYCE CHIROPRACTIC LISLE
Entity type:Organization
Organization Name:BOYCE CHIROPRACTIC LISLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KEUSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-308-4585
Mailing Address - Street 1:4716 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1726
Mailing Address - Country:US
Mailing Address - Phone:708-446-0117
Mailing Address - Fax:
Practice Address - Street 1:4716 MAIN ST
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1726
Practice Address - Country:US
Practice Address - Phone:708-446-0117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUSTIN BOYCE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty