Healthcare Provider Details

I. General information

NPI: 1679619829
Provider Name (Legal Business Name): BOARDMAN FAMILY CHIROPRACTIC PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 EASTERN BYP STE A
RICHMOND KY
40475-3326
US

IV. Provider business mailing address

837 EASTERN BYP STE A
RICHMOND KY
40475-3326
US

V. Phone/Fax

Practice location:
  • Phone: 606-831-4432
  • Fax: 859-623-2037
Mailing address:
  • Phone: 606-831-4432
  • Fax: 859-623-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JEREMIAH HOLMES
Title or Position: DC OWNER
Credential:
Phone: 606-831-4432