Provider Demographics
NPI:1114478872
Name:BOYESON, MATTHEW PETER (DC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:PETER
Last Name:BOYESON
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 1:6030 SAINT ANDREWS RD
Mailing Address - Street 2:STE M
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-3164
Mailing Address - Country:US
Mailing Address - Phone:803-238-3433
Mailing Address - Fax:
Practice Address - Street 1:6030 SAINT ANDREWS RD
Practice Address - Street 2:STE M
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3164
Practice Address - Country:US
Practice Address - Phone:803-238-3433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4349111N00000X
KY5511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100431890Medicaid
KYK218270Medicare PIN