Provider Demographics
NPI:1013069459
Name:BOYD, BRIAN PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PATRICK
Last Name:BOYD
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 1:518 HILLGROVE AVE STE 275
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1460
Mailing Address - Country:US
Mailing Address - Phone:708-588-8270
Mailing Address - Fax:708-588-8271
Practice Address - Street 1:16W501 NIELSON LN
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-6826
Practice Address - Country:US
Practice Address - Phone:630-455-5885
Practice Address - Fax:630-455-5929
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1632424OtherBLUE CROSS BLUE SHIELD IL
IL1632424OtherBLUE CROSS BLUE SHIELD IL