Provider Demographics
NPI:1417138926
Name:BOYER CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:BOYER CHIROPRACTIC, INC.
Other - Org Name:LISA BOYER CHIROPRACTIC, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:GREGG
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-250-1125
Mailing Address - Street 1:4019 WESTERLY PL #101
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-250-1125
Mailing Address - Fax:949-250-5841
Practice Address - Street 1:4019 WESTERLY PL #101
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-250-1125
Practice Address - Fax:949-250-5841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22946302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU47736Medicare UPIN