MEDICARE: DR. SCOTT EDWARD BOULEY DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	15670	TX

General Provider Information

NPI Number	:	1154002921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT EDWARD BOULEY DC

Provider Business Mailing Address
First Line	:	527 SUN VALLEY DR
Second Line	:
City	:	DUNCANVILLE
State	:	TX
Zip	:	75116-2409
Country	:	US
Telephone Number	:	719-464-6109
Fax Number	:

Provider Business Practice Location Address
First Line	:	1014 S MAIN ST
Second Line	:
City	:	DUNCANVILLE
State	:	TX
Zip	:	75137-2320
Country	:	US
Telephone Number	:	972-296-1566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2023
Last Update Date	:	07/26/2023

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