Provider Demographics
NPI:1235195280
Name:BOYLES, GERALD VANCE (DC)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:VANCE
Last Name:BOYLES
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 1:507 ELM ST W
Mailing Address - Street 2:PO BOX 283
Mailing Address - City:HAMPTON
Mailing Address - State:SC
Mailing Address - Zip Code:29924-3101
Mailing Address - Country:US
Mailing Address - Phone:803-943-5774
Mailing Address - Fax:803-943-2162
Practice Address - Street 1:507 ELM ST W
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:SC
Practice Address - Zip Code:29924-3101
Practice Address - Country:US
Practice Address - Phone:803-943-5774
Practice Address - Fax:803-943-2162
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2357Medicaid