Provider Demographics
NPI:1336125889
Name:BOYLE, KENNETH L (DC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:L
Last Name:BOYLE
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 1:715 SCISSORTAIL LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-3749
Mailing Address - Country:US
Mailing Address - Phone:919-622-0198
Mailing Address - Fax:919-303-2501
Practice Address - Street 1:211 S SALEM ST
Practice Address - Street 2:STE C
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1878
Practice Address - Country:US
Practice Address - Phone:919-303-2500
Practice Address - Fax:919-303-2501
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890849UMedicaid
U83745Medicare UPIN
NC890849UMedicaid