Healthcare Provider Details

I. General information

NPI: 1649089905
Provider Name (Legal Business Name): GRACE BOUQUET BOYLE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MAIN ST W
WABASHA MN
55981-1236
US

IV. Provider business mailing address

131 MAIN ST W
WABASHA MN
55981-1236
US

V. Phone/Fax

Practice location:
  • Phone: 651-565-4863
  • Fax:
Mailing address:
  • Phone: 651-565-4863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7288
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: