Dr Charles Boag PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

756 Issued in AZ

Legal business name

DR CHARLES BOAG PC

Practice address

4515 W Indian School Rd
Boag Chiropractic
Phoenix, AZ 85031-2820

Phone

(602) 269-5717

Fax

(602) 269-5718

NPI assigned

Feb 1, 2008

Organization subpart

No

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

Authorized official

Name

Charles Brixner Boag Jr., CHIROPRACTOR

Title

President Owner

Phone

(602) 269-5717

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1201824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205625600000",
    "number": "1821276742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4515 W INDIAN SCHOOL RD",
            "address_2": "BOAG CHIROPRACTIC",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850312820",
            "telephone_number": "602-269-5717",
            "fax_number": "602-269-5718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4515 W INDIAN SCHOOL RD",
            "address_2": "BOAG CHIROPRACTIC",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850312820",
            "telephone_number": "602-269-5717",
            "fax_number": "602-269-5718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR CHARLES BOAG PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-01",
        "last_updated": "2008-03-16",
        "status": "A",
        "authorized_official_last_name": "BOAG",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "BRIXNER",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "602-269-5717",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "CHIROPRACTOR"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "756",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA CHIROPRACTICE LIC",
            "identifier": "756",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE LEGACY",
            "identifier": "1C526804797",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2008; 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.