Provider Demographics
NPI:1447273214
Name:BOYCE, JUSTIN BENNETT (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:BENNETT
Last Name:BOYCE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 W DIVERSEY PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6505
Mailing Address - Country:US
Mailing Address - Phone:773-472-7484
Mailing Address - Fax:773-472-6716
Practice Address - Street 1:757 W DIVERSEY PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6505
Practice Address - Country:US
Practice Address - Phone:773-472-7484
Practice Address - Fax:773-472-6716
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT36410Medicare UPIN
IL208321Medicare ID - Type Unspecified