Healthcare Provider Details

I. General information

NPI: 1427052935
Provider Name (Legal Business Name): MICHAEL G BOYRER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
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 D
ESTERO FL
33928-4140
US

V. Phone/Fax

Practice location:
  • Phone: 239-948-1222
  • Fax: 239-948-1220
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:
Title or Position:
Credential:
Phone: