Healthcare Provider Details

I. General information

NPI: 1285892760
Provider Name (Legal Business Name): BOYRER CHIROPRACTIC P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19910 S TAMIAMI TRL STE D
ESTERO FL
33928-4140
US

IV. Provider business mailing address

19910 S TAMIAMI TRL STE C
ESTERO FL
33928-4140
US

V. Phone/Fax

Practice location:
  • Phone: 239-948-1222
  • Fax:
Mailing address:
  • Phone: 239-948-1222
  • Fax: 239-948-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7822
License Number StateFL

VIII. Authorized Official

Name: KRISTINA D WILLIAMS
Title or Position: OFFICE MANAGER
Credential:
Phone: 239-948-1222