Provider Demographics
NPI:1376608570
Name:BOYD, BRIAN DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DALE
Last Name:BOYD
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 1:10700 HIGHWAY 55
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6100
Mailing Address - Country:US
Mailing Address - Phone:763-543-9080
Mailing Address - Fax:763-543-9082
Practice Address - Street 1:10700 HIGHWAY 55
Practice Address - Street 2:SUITE 100
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6100
Practice Address - Country:US
Practice Address - Phone:763-543-9080
Practice Address - Fax:763-543-9082
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU76269Medicare UPIN