MEDICARE: DEBOER CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1043961709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBOER CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	2433 ONTARIO ST STE B
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-2700
Country	:	US
Telephone Number	:	708-895-1798
Fax Number	:

Provider Business Practice Location Address
First Line	:	2433 ONTARIO ST STE B
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-2700
Country	:	US
Telephone Number	:	708-895-1798
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL A. DEBOER
Credential	:	DC
Telephone Number	:	708-895-1798

Provider Enumeration Date	:	01/14/2022
Last Update Date	:	01/14/2022

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