Healthcare Provider Details

I. General information

NPI: 1962753665
Provider Name (Legal Business Name): BOISVERT ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2459 NICHOLASVILLE RD STE 150
LEXINGTON KY
40503-3181
US

IV. Provider business mailing address

2459 NICHOLASVILLE RD STE 150
LEXINGTON KY
40503-3181
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-8000
  • Fax: 859-523-0474
Mailing address:
  • Phone: 859-278-8000
  • Fax: 859-523-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number5052
License Number StateKY

VIII. Authorized Official

Name: DR. LEO R BOISVERT
Title or Position: OWNER/DOCTOR
Credential: D.C.
Phone: 859-354-7041