Provider Demographics
NPI:1730395781
Name:R. A. BOISVERT, D.C.
Entity type:Organization
Organization Name:R. A. BOISVERT, D.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOISVERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-442-8838
Mailing Address - Street 1:5501 COLISEUM BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3708
Mailing Address - Country:US
Mailing Address - Phone:318-442-8838
Mailing Address - Fax:
Practice Address - Street 1:5501 COLISEUM BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3708
Practice Address - Country:US
Practice Address - Phone:318-442-8838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9 & 915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty