Healthcare Provider Details

I. General information

NPI: 1588914667
Provider Name (Legal Business Name): CHRIS BOYSON CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2000 S MEMORIAL DR FRONT
APPLETON WI
54915-1284
US

IV. Provider business mailing address

2000 S. MEMORIAL DR. FRONT
APPLETON WI
54915
US

V. Phone/Fax

Practice location:
  • Phone: 920-997-8268
  • Fax: 920-997-8268
Mailing address:
  • Phone: 920-997-8268
  • Fax: 920-997-8268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2168-12
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number26410-20
License Number StateWI

VIII. Authorized Official

Name: DR. CHRIS W BOYSON
Title or Position: OWNER
Credential: DC
Phone: 920-997-8268