Healthcare Provider Details

I. General information

NPI: 1871273789
Provider Name (Legal Business Name): BOARDMAN CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 TRAILWOOD DR STE 1
YOUNGSTOWN OH
44512-5037
US

IV. Provider business mailing address

PO BOX 5254
POLAND OH
44514-0254
US

V. Phone/Fax

Practice location:
  • Phone: 330-953-3353
  • Fax: 330-953-3356
Mailing address:
  • Phone: 330-520-2221
  • Fax: 330-776-5557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN BRAATZ
Title or Position: OWNER
Credential: DC
Phone: 330-953-3353