Provider Demographics
NPI:1063693935
Name:BOYLAN CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BOYLAN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOYLAN
Authorized Official - Suffix:IX
Authorized Official - Credentials:DC
Authorized Official - Phone:203-743-2225
Mailing Address - Street 1:2 LIBRARY PLACE
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-2106
Mailing Address - Country:US
Mailing Address - Phone:203-743-2225
Mailing Address - Fax:203-790-1421
Practice Address - Street 1:2 LIBRARY PLACE
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-2106
Practice Address - Country:US
Practice Address - Phone:203-743-2225
Practice Address - Fax:203-790-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT658261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350000469Medicare PIN
CTT78364Medicare UPIN