Provider Demographics
NPI:1699959916
Name:THE BOONE CLINIC, P.C.
Entity type:Organization
Organization Name:THE BOONE CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-498-7879
Mailing Address - Street 1:5370 STONE MOUNTAIN HWY
Mailing Address - Street 2:SUITE 730
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3581
Mailing Address - Country:US
Mailing Address - Phone:770-498-7879
Mailing Address - Fax:
Practice Address - Street 1:5370 STONE MOUNTAIN HWY
Practice Address - Street 2:SUITE 730
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3581
Practice Address - Country:US
Practice Address - Phone:770-498-7879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU95730Medicare UPIN