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General NPI Number Information
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NPI Number | 1265253710
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Entity Type | Individual
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Provider Name | GREGORY JOSEPH BOULES DC
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Gender | Male
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 406 S PROSPECTORS RD
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City | DIAMOND BAR
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State | CA
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Zip | 91765-1659
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Country | US
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Telephone | 909-860-0148
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Fax |
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Provider Business Mailing Address
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Address Line | 20575 EASTHILL DR
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City | YORBA LINDA
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State | CA
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Zip | 92887-3227
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 37096
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License Number State | CA
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