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General NPI Number Information
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NPI Number | 1427345883
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Entity Type | Organization
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Legal Business Name | BONEYARD CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 07/06/2011
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 27108 OAKMEAD DR
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City | PERRYSBURG
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State | OH
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Zip | 43551-2670
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Country | US
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Telephone | 419-872-2100
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Fax | 419-872-2282
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Provider Business Mailing Address
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Address Line | 27108 OAKMEAD DR
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City | PERRYSBURG
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State | OH
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Zip | 43551-2670
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Country | US
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Telephone | 419-872-2100
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Fax | 419-872-2282
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Authorized Official
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Title or Position | OWNER
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Name | JAQUES SAVOIE
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Credential | DC
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Telephone | 419-872-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301008306
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License Number State | MI
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