Provider Demographics
NPI:1295812550
Name:BOYER, PETER VICTOR (DC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:VICTOR
Last Name:BOYER
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 1:8136 OLD KEENE MILL RD
Mailing Address - Street 2:A314
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1850
Mailing Address - Country:US
Mailing Address - Phone:703-644-9311
Mailing Address - Fax:703-644-3907
Practice Address - Street 1:8136 OLD KEENE MILL RD
Practice Address - Street 2:A314
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1850
Practice Address - Country:US
Practice Address - Phone:703-644-9311
Practice Address - Fax:703-644-3907
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA238757Medicare PIN