Provider Demographics
NPI:1356417067
Name:BOOTS, JAMES ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:BOOTS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1020 TRUMAN STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:KIMBERLY
Mailing Address - State:WI
Mailing Address - Zip Code:54136
Mailing Address - Country:US
Mailing Address - Phone:920-997-9700
Mailing Address - Fax:920-997-0060
Practice Address - Street 1:1020 TRUMAN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:KIMBERLY
Practice Address - State:WI
Practice Address - Zip Code:54136
Practice Address - Country:US
Practice Address - Phone:920-997-9700
Practice Address - Fax:920-997-0060
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2055012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38792900Medicaid
WI38792900Medicaid