Provider Demographics
NPI:1427159052
Name:BOYLAN, DONNA MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIE
Last Name:BOYLAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LIBRARY PL
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 PL
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350000469Medicare PIN