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General NPI Number Information
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NPI Number | 1649455502
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Entity Type | Individual
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Provider Name | JOHN NOLAN BOUMA DC
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Gender | Male
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 02/20/2008
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Provider Practice Location Address
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Address Line | 419 CENTER ST SUITE B
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City | GRAYSLAKE
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State | IL
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Zip | 60030-1625
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Country | US
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Telephone | 847-543-1055
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Fax | 847-543-8648
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Provider Business Mailing Address
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Address Line | 419 CENTER ST SUITE B
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City | GRAYSLAKE
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State | IL
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Zip | 60030-1625
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Country | US
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Telephone | 847-543-1055
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Fax | 847-543-8648
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 |
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License Number State | IL
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