Provider Demographics
NPI:1073577763
Name:BOYE, MARIAN L (DC)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:L
Last Name:BOYE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1157
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0030
Mailing Address - Country:US
Mailing Address - Phone:541-469-3446
Mailing Address - Fax:541-469-7012
Practice Address - Street 1:97829 SHOPPING CENTER AVE STE F
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9135
Practice Address - Country:US
Practice Address - Phone:541-469-3446
Practice Address - Fax:541-469-7012
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR085444Medicaid
014146000OtherBX
P00004353OtherRR MC B
U22098Medicare UPIN