Provider Demographics
NPI:1780116335
Name:BOYER CHIROPRACTIC AND WELLNESS CENTER PC
Entity type:Organization
Organization Name:BOYER CHIROPRACTIC AND WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-354-2617
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:ELDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:15736-0236
Mailing Address - Country:US
Mailing Address - Phone:724-354-2617
Mailing Address - Fax:724-354-2703
Practice Address - Street 1:215 SOUTH LYTLE STREET
Practice Address - Street 2:
Practice Address - City:ELDERTON
Practice Address - State:PA
Practice Address - Zip Code:15736-0236
Practice Address - Country:US
Practice Address - Phone:724-354-2617
Practice Address - Fax:724-354-2703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU95649Medicare UPIN