Robert Ray Boardman IV, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4366 Issued in KY

Practice address

12464 La Grange Rd
Louisville, KY 40245-1901

Phone

(502) 205-2090

Fax

(502) 205-2091

NPI assigned

Jul 5, 2005

Reactivated

Apr 5, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Spine Stop Franklin, PLLC

  • Chiropractor
  • Franklin, KY
  • NPI 1255016218
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1467459529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12464 LA GRANGE RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402451901",
            "telephone_number": "502-205-2090",
            "fax_number": "502-205-2091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12464 LA GRANGE RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402451901",
            "telephone_number": "502-205-2090",
            "fax_number": "502-205-2091"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "220 Geri Ln",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "KY",
            "postal_code": "404752689",
            "country_code": "US",
            "telephone_number": "859-623-4123",
            "fax_number": "859-623-2037",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOARDMAN",
        "first_name": "ROBERT",
        "middle_name": "RAY",
        "name_suffix": "IV",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-05",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "deactivation_date": "2006-03-20",
        "reactivation_date": "2006-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "KY",
            "license": "4366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000192198",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHA",
            "identifier": "000000088188",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7646218",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Board of Education of Jefferson County Kentucky
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• Delora K. Boaz, LCSW, LCADC
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• Viorel Boborodea, MD

• Chiropractor in Louisville, KY
• Providers in Louisville, KY by specialty
• Chiropractor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.