Provider Demographics
NPI:1912073024
Name:BOSHELL CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:BOSHELL CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MURIS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BOSHELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:205-486-2000
Mailing Address - Street 1:8177 HWY 13
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-0077
Mailing Address - Country:US
Mailing Address - Phone:205-486-2000
Mailing Address - Fax:205-486-4406
Practice Address - Street 1:8177 HWY 13
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-0077
Practice Address - Country:US
Practice Address - Phone:205-486-2000
Practice Address - Fax:205-486-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRAY 1461 - AMY1789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherTAX IDENTIFICATION #
ALK533Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #