Provider Demographics
NPI:1790390177
Name:DIRECT CARE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DIRECT CARE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-278-1340
Mailing Address - Street 1:212 NW 135TH WAY
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-3694
Mailing Address - Country:US
Mailing Address - Phone:352-278-1340
Mailing Address - Fax:
Practice Address - Street 1:212 NW 135TH WAY
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-3694
Practice Address - Country:US
Practice Address - Phone:352-278-1340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty