Provider Demographics
NPI:1174691463
Name:BOYER, KIMBERLY A (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:BOYER
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 1:15 CLUBHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17963-9474
Mailing Address - Country:US
Mailing Address - Phone:570-345-5046
Mailing Address - Fax:570-345-5065
Practice Address - Street 1:15 CLUBHOUSE RD
Practice Address - Street 2:
Practice Address - City:PINE GROVE
Practice Address - State:PA
Practice Address - Zip Code:17963-9474
Practice Address - Country:US
Practice Address - Phone:570-345-5046
Practice Address - Fax:570-345-5065
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV11851Medicare UPIN
PA114763Medicare PIN