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General NPI Number Information
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NPI Number | 1063693935
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Entity Type | Organization
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Legal Business Name | BOYLAN CHIROPRACTIC LLC
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Dates
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Enumeration Date | 11/20/2007
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 2 LIBRARY PLACE
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City | BETHEL
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State | CT
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Zip | 06801-2106
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Country | US
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Telephone | 203-743-2225
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Fax | 203-790-1421
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Provider Business Mailing Address
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Address Line | 2 LIBRARY PLACE
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City | BETHEL
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State | CT
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Zip | 06801-2106
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Country | US
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Telephone | 203-743-2225
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Fax | 203-790-1421
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONNA MARIE BOYLAN IX
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Credential | D.C.
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Telephone | 203-743-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 658
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License Number State | CT
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