Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1289 | GA |
N | 111NN0400X | Neurology | 1289 | GA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 1289 | GA |
NPI | 1821339375 |
---|---|
Provider Name | Dr. John W Boyer |
First Address | Stone Mountain, GA 30087-1846 |
Second Address | Stone Mountain, GA 30087-1846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2013 |
Last Update Date | 08/03/2013 |