Provider Demographics
NPI:1194951046
Name:BOERJAN, BRYAN THOMAS (DC)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:THOMAS
Last Name:BOERJAN
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 1:1101 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:850-741-3482
Mailing Address - Fax:833-740-4325
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:850-741-3482
Practice Address - Fax:833-740-4325
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9889111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor