| Boonville Chiropractic Llc | |
|
321 Main St Boonville MO 65233-1565 | |
| (660) 882-5775 | |
| Not Available |
| Full Name | Boonville Chiropractic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 321 Main St, Boonville, Missouri |
| Authorized Official Name and Position | Tanner Green (OWNER) |
| Authorized Official Contact | 6605374773 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Boonville Chiropractic Llc 321 Main St Boonville MO 65233-1565 Ph: (660) 882-5775 | Boonville Chiropractic Llc 321 Main St Boonville MO 65233-1565 Ph: (660) 882-5775 |
| NPI Number | 1154090710 |
|---|---|
| Provider Enumeration Date | 09/08/2021 |
| Last Update Date | 09/08/2021 |
| Medicare PECOS PAC ID | 5597163675 |
|---|---|
| Medicare Enrollment ID | O20211004001307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154090710 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Tanner Wayne Green |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1578146841 PECOS PAC ID: 6406254580 Enrollment ID: I20211004001396 |
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