Provider Demographics
NPI:1366739146
Name:BOYLAN, WILLIAM DAVID (LICAC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:DAVID
Last Name:BOYLAN
Suffix:
Gender:M
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TIMBERWOOD DR UNIT 206
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045-2560
Mailing Address - Country:US
Mailing Address - Phone:603-669-0808
Mailing Address - Fax:
Practice Address - Street 1:400 BEDFORD ST # 104
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1195
Practice Address - Country:US
Practice Address - Phone:603-669-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHACP 182171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist