Individual
MR. JOHN NOLAN BOUMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
419 CENTER ST, SUITE B, GRAYSLAKE, IL 60030-1625
(847) 543-1055
(847) 543-8648
Mailing address
419 CENTER ST, SUITE B, GRAYSLAKE, IL 60030-1625
(847) 543-1055
(847) 543-8648
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4915076
BCBS
IL
Enumeration date
01/09/2008
Last updated
02/20/2008
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