Provider Demographics
NPI:1568806156
Name:DR. THOMAS R. BOYER, PC
Entity Type:Organization
Organization Name:DR. THOMAS R. BOYER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-743-1424
Mailing Address - Street 1:717 D ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1826
Mailing Address - Country:US
Mailing Address - Phone:208-743-1424
Mailing Address - Fax:208-743-2803
Practice Address - Street 1:717 D ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1826
Practice Address - Country:US
Practice Address - Phone:208-743-1424
Practice Address - Fax:208-743-2803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1568806156OtherMEDICARE NPI
ID1386628337OtherMEDICARE NPI
ID1672073OtherMEDICARE PTAN