Active NPI
Charles Leon Boulton, DC
- Chiropractor
- La Center, KY
National Provider Identifier
1801163522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 3628 R
- Practice address
- 245 Broadway
La Center, KY 42056 - Phone
- (270) 665-5568
- Fax
- (270) 665-5568
- NPI assigned
- Nov 23, 2011
- Last updated
- Nov 23, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3628 R | KY | Primary |
Addresses
Primary practice location
245 Broadway
La Center, KY 42056
Mailing address
PO Box 805
245 Broadway
La Center, KY 42056
Phone (270) 665-5568
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3628 R | KY | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322006400000",
"number": "1801163522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 805",
"address_2": "245 BROADWAY",
"city": "LA CENTER",
"state": "KY",
"postal_code": "42056",
"telephone_number": "270-665-5568",
"fax_number": "270-665-5568"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "245 BROADWAY",
"city": "LA CENTER",
"state": "KY",
"postal_code": "42056",
"telephone_number": "270-665-5568",
"fax_number": "270-665-5568"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULTON",
"first_name": "CHARLES",
"middle_name": "LEON",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-11-23",
"last_updated": "2011-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "KY",
"license": "3628 R",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Center, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.