Individual
ROBERT RAY BOARDMAN IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
12464 LA GRANGE RD, LOUISVILLE, KY 40245-1901
(502) 205-2090
(502) 205-2091
Mailing address
12464 LA GRANGE RD, LOUISVILLE, KY 40245-1901
(502) 205-2090
(502) 205-2091
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4366
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000088188
CHA
KY
01
—
000000192198
ANTHEM BCBS
KY
01
—
7646218
AETNA
KY
Enumeration date
07/05/2005
Last updated
11/20/2023
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