Provider Demographics
NPI:1841675493
Name:BOYD CHIROPRACTIC AND REHAB LLC
Entity type:Organization
Organization Name:BOYD CHIROPRACTIC AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-569-2354
Mailing Address - Street 1:550 FULLERTON AVE
Mailing Address - Street 2:PO BOX 87504
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-5400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:923 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5650
Practice Address - Country:US
Practice Address - Phone:630-665-7266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012848111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty