Organization
DR CHARLES BOAG PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES BRIXNER BOAG JR. CHIROPRACTOR (PRESIDENT OWNER)
(602) 269-5717
Entity
Organization
Contact information
Practice address
4515 W INDIAN SCHOOL RD, BOAG CHIROPRACTIC, PHOENIX, AZ 85031-2820
(602) 269-5717
(602) 269-5718
Mailing address
4515 W INDIAN SCHOOL RD, BOAG CHIROPRACTIC, PHOENIX, AZ 85031-2820
(602) 269-5717
(602) 269-5718
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
756
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1C526804797
MEDICARE LEGACY
—
01
—
756
ARIZONA CHIROPRACTICE LIC
—
Enumeration date
02/01/2008
Last updated
03/16/2008
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