Provider Demographics
NPI:1427345883
Name:BONEYARD CHIROPRACTIC CLINIC LLC
Entity type:Organization
Organization Name:BONEYARD CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAQUES
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVOIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-872-2100
Mailing Address - Street 1:27108 OAKMEAD DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2670
Mailing Address - Country:US
Mailing Address - Phone:419-872-2100
Mailing Address - Fax:419-872-2282
Practice Address - Street 1:27108 OAKMEAD DR
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2670
Practice Address - Country:US
Practice Address - Phone:419-872-2100
Practice Address - Fax:419-872-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty