Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 14701 | TX |
Y | 111NN1001X | Nutrition | DC36033 | CA |
NPI | 1316530181 |
---|---|
Provider Name | Dr. Mandy Ann Boyle |
First Address | Arroyo Grande, CA 93420-1315 |
Second Address | San Luis Obispo, CA 93401-4635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2021 |
Last Update Date | 08/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
87-3154296 | OUT OF NETWORK (01) | CA |