Provider Demographics
NPI:1184763021
Name:JUSTIN BOYCE P.C.
Entity type:Organization
Organization Name:JUSTIN BOYCE P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:BOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-472-7484
Mailing Address - Street 1:757 W DIVERSEY PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:757 W DIVERSEY PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6505
Practice Address - Country:US
Practice Address - Phone:773-472-7484
Practice Address - Fax:773-472-6716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010051111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1616934OtherBCBS PROVIDER NUMBER
ILT36410Medicare UPIN
IL208321Medicare ID - Type Unspecified