Provider Demographics
NPI:1164552956
Name:BOYD-OLSON CHIROPRACTIC
Entity Type:Organization
Organization Name:BOYD-OLSON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-943-9474
Mailing Address - Street 1:224 BIRMINGHAM DR STE 1C
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1743
Mailing Address - Country:US
Mailing Address - Phone:760-943-9474
Mailing Address - Fax:760-943-9631
Practice Address - Street 1:224 BIRMINGHAM DR
Practice Address - Street 2:SUITE 1C
Practice Address - City:CARDIFF
Practice Address - State:CA
Practice Address - Zip Code:92007-1758
Practice Address - Country:US
Practice Address - Phone:760-943-9474
Practice Address - Fax:760-943-9631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13783Medicare PIN