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General NPI Number Information
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NPI Number | 1720806854
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Entity Type | Individual
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Provider Name | JACK THEODORE BOYLE DC
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Gender | Male
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Dates
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Enumeration Date | 09/27/2024
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 4421 NE ST JOHNS RD STE F
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City | VANCOUVER
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State | WA
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Zip | 98661-2573
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Country | US
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Telephone | 360-576-1600
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Fax | 360-693-0078
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Provider Business Mailing Address
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Address Line | 4421 NE ST JOHNS RD STE F
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City | VANCOUVER
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State | WA
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Zip | 98661-2573
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Country | US
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Telephone | 360-576-1600
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Fax | 360-903-8371
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CH61609487
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License Number State | WA
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