Provider Demographics
NPI:1871273789
Name:BOARDMAN CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BOARDMAN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-953-3353
Mailing Address - Street 1:PO BOX 5254
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-0254
Mailing Address - Country:US
Mailing Address - Phone:330-520-2221
Mailing Address - Fax:330-776-5557
Practice Address - Street 1:918 TRAILWOOD DR STE 1
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5037
Practice Address - Country:US
Practice Address - Phone:330-953-3353
Practice Address - Fax:330-953-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty