Provider Demographics
NPI:1598587479
Name:BOULES CHIROPRACTIC INC
Entity type:Organization
Organization Name:BOULES CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BOULES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-398-7324
Mailing Address - Street 1:406 S PROSPECTORS RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1659
Mailing Address - Country:US
Mailing Address - Phone:909-860-0148
Mailing Address - Fax:
Practice Address - Street 1:406 S PROSPECTORS RD
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1659
Practice Address - Country:US
Practice Address - Phone:909-860-0148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty