Provider Demographics
NPI:1073739173
Name:BOYD, KENDALL W (DC)
Entity Type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:W
Last Name:BOYD
Suffix:
Gender:M
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 113
Mailing Address - Street 2:
Mailing Address - City:JAL
Mailing Address - State:NM
Mailing Address - Zip Code:88252-0113
Mailing Address - Country:US
Mailing Address - Phone:505-395-2311
Mailing Address - Fax:
Practice Address - Street 1:101 W UTAH
Practice Address - Street 2:
Practice Address - City:JAL
Practice Address - State:NM
Practice Address - Zip Code:88252
Practice Address - Country:US
Practice Address - Phone:505-395-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor