Healthcare Provider Details

I. General information

NPI: 1508071457
Provider Name (Legal Business Name): FOX VALLEY PHYSICIAN SERVICES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 N LINCOLNWAY
NORTH AURORA IL
60506-1635
US

IV. Provider business mailing address

23 N LINCOLNWAY
NORTH AURORA IL
60506-1635
US

V. Phone/Fax

Practice location:
  • Phone: 630-966-2637
  • Fax: 630-966-1611
Mailing address:
  • Phone: 630-966-2637
  • Fax: 630-966-1611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ROBERT W BOER
Title or Position: OWNER
Credential: DC PAC
Phone: 630-966-2637