Provider Demographics
NPI:1740774314
Name:BOYLAN, PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:BOYLAN
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 1:7110 OAKLAND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1870
Mailing Address - Country:US
Mailing Address - Phone:314-325-0425
Mailing Address - Fax:314-552-7294
Practice Address - Street 1:7110 OAKLAND AVE STE 102
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1870
Practice Address - Country:US
Practice Address - Phone:314-325-0425
Practice Address - Fax:314-552-7294
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018001728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty