Provider Demographics
NPI:1275840241
Name:BOYER, LUKE (DC)
Entity Type:Individual
Prefix:MR
First Name:LUKE
Middle Name:
Last Name:BOYER
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 817
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-0030
Mailing Address - Country:US
Mailing Address - Phone:425-557-3636
Mailing Address - Fax:425-557-3605
Practice Address - Street 1:22525 SE 64TH PL
Practice Address - Street 2:STE 200
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5307
Practice Address - Country:US
Practice Address - Phone:425-557-3636
Practice Address - Fax:425-557-3605
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60167197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8897296Medicare UPIN