Provider Demographics
NPI:1588914667
Name:CHRIS BOYSON CHIROPRACTIC
Entity type:Organization
Organization Name:CHRIS BOYSON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOYSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-997-8268
Mailing Address - Street 1:2000 S. MEMORIAL DR.
Mailing Address - Street 2:FRONT
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915
Mailing Address - Country:US
Mailing Address - Phone:920-997-8268
Mailing Address - Fax:920-997-8268
Practice Address - Street 1:2000 S MEMORIAL DR
Practice Address - Street 2:FRONT
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1284
Practice Address - Country:US
Practice Address - Phone:920-997-8268
Practice Address - Fax:920-997-8268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26410-202083X0100X
WI2168-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty