Provider Demographics
NPI:1396993432
Name:BOICE, JUDITH LYNETTE (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:LYNETTE
Last Name:BOICE
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:846 SW BEAVER LN
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-9303
Mailing Address - Country:US
Mailing Address - Phone:541-475-5525
Mailing Address - Fax:541-475-2131
Practice Address - Street 1:66 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1427
Practice Address - Country:US
Practice Address - Phone:541-475-5525
Practice Address - Fax:541-475-5525
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO711171100000X
ORAC00332171100000X
OR821175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist