=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811959877
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK E BOYLAN D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 W MAIN ST
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32712-3451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-886-2299
-----------------------------------------------------
Fax | 407-886-1227
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 316 S CENTRAL AVE
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32703-4246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-886-2299
-----------------------------------------------------
Fax | 407-886-1227
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH0003217
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------