Provider Demographics
NPI:1649211392
Name:BOYD CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:BOYD CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALEXVICZH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-836-0440
Mailing Address - Street 1:3271 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-2537
Mailing Address - Country:US
Mailing Address - Phone:814-836-0440
Mailing Address - Fax:814-835-0256
Practice Address - Street 1:3271 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-2537
Practice Address - Country:US
Practice Address - Phone:814-836-0440
Practice Address - Fax:814-835-0256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006482L111N00000X
PADC006488L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1649211392OtherNPI