Provider Demographics
NPI:1497141493
Name:BOYD, MITCH (DC)
Entity Type:Individual
Prefix:
First Name:MITCH
Middle Name:
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 1:303 N NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3396
Mailing Address - Country:US
Mailing Address - Phone:847-382-3194
Mailing Address - Fax:
Practice Address - Street 1:303 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3396
Practice Address - Country:US
Practice Address - Phone:847-382-3194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor