Provider Demographics
NPI:1750641387
Name:DARVIL L BOREN DC PC
Entity Type:Organization
Organization Name:DARVIL L BOREN DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARVIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-428-7277
Mailing Address - Street 1:212 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-2334
Mailing Address - Country:US
Mailing Address - Phone:928-428-7277
Mailing Address - Fax:
Practice Address - Street 1:212 W 5TH ST
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-2334
Practice Address - Country:US
Practice Address - Phone:928-428-7277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NONE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0932490OtherBLUE CROSS BLUE SHIELD
AZT90982Medicare UPIN