Provider Demographics
NPI:1316452683
Name:BOYD CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:BOYD CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:749-749-7997
Mailing Address - Street 1:10802 QUAIL PLAZA DR STE 300
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3122
Mailing Address - Country:US
Mailing Address - Phone:405-749-7997
Mailing Address - Fax:405-749-5031
Practice Address - Street 1:10802 QUAIL PLAZA DR STE 300
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3122
Practice Address - Country:US
Practice Address - Phone:405-749-7997
Practice Address - Fax:405-749-5031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty