Provider Demographics
NPI:1609031624
Name:BROYLES, HARRY CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:CHARLES
Last Name:BROYLES
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 1:228 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-3541
Mailing Address - Country:US
Mailing Address - Phone:912-287-1414
Mailing Address - Fax:912-287-1884
Practice Address - Street 1:228 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-3541
Practice Address - Country:US
Practice Address - Phone:912-287-1414
Practice Address - Fax:912-287-1884
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I350169Medicare PIN