Provider Demographics
NPI:1790806461
Name:BOYD, MICHELLE MCPOLIN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MCPOLIN
Last Name:BOYD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 N LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-5622
Mailing Address - Country:US
Mailing Address - Phone:708-588-8270
Mailing Address - Fax:708-588-8271
Practice Address - Street 1:355 N LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE PARK
Practice Address - State:IL
Practice Address - Zip Code:60526-5622
Practice Address - Country:US
Practice Address - Phone:708-588-8270
Practice Address - Fax:708-588-8271
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38009671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632424OtherBLUE CROSS BLUE SHIELD
ILK18394Medicare PIN
IL01632424OtherBLUE CROSS BLUE SHIELD