Provider Demographics
NPI:1821165523
Name:BORO, WILLIAM J (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:BORO
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 1:108 OLD SOLOMONS ISLAND RD
Mailing Address - Street 2:BLDG 2 STE A
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-266-5054
Mailing Address - Fax:410-266-6205
Practice Address - Street 1:108 OLD SOLOMONS ISLAND RD
Practice Address - Street 2:BLDG 2 STE A
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-266-5054
Practice Address - Fax:410-266-6205
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD501194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD58850001OtherBLUE CROSS BLUE SHIELD
MDM107OtherCAREFIRST BLUE CROSS BLUE
MDM107Medicare ID - Type Unspecified
T59535Medicare UPIN