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General NPI Number Information
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NPI Number | 1780112847
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Entity Type | Individual
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Provider Name | JESSICA MAE BOYLES DC
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Gender | Female
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Dates
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Enumeration Date | 06/01/2017
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Last Update Date | 08/08/2019
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Provider Practice Location Address
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Address Line | 7301 OHMS LN STE 430
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City | EDINA
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State | MN
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Zip | 55439-2376
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Country | US
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Telephone | 612-564-0403
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Fax |
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Provider Business Mailing Address
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Address Line | 15512 RIDGEMONT AVE SE
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City | PRIOR LAKE
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State | MN
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Zip | 55372-1840
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Country | US
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Telephone | 952-201-2132
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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 | 6377
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License Number State | MN
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