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Organization
PREMIER CHIROPRACTIC CENTER, LTD
Active
Organization
PREMIER CHIROPRACTIC CENTER, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN NOLAN BOUMA (PHYSICIAN)
(847) 543-1055
Entity
Organization
Contact information
Practice address
419 CENTER ST, SUITE B, GRAYSLAKE, IL 60030-1625
(847) 543-1055
Mailing address
419 CENTER ST, SUITE B, GRAYSLAKE, IL 60030-1625
(847) 543-1055
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4926003
BCBS ID #
IL
Enumeration date
08/02/2006
Last updated
01/11/2008
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