Provider Demographics
NPI:1780403279
Name:DR BRYAN BOERJAN CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:DR BRYAN BOERJAN CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOERJAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-821-8347
Mailing Address - Street 1:1101 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-3235
Mailing Address - Country:US
Mailing Address - Phone:850-738-1515
Mailing Address - Fax:
Practice Address - Street 1:1101 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3235
Practice Address - Country:US
Practice Address - Phone:850-738-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty