Provider Demographics
NPI:1366563470
Name:BOYER, LISA GREGG (DC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GREGG
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 1:4019 WESTERLY PLACE
Mailing Address - Street 2:#101
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-250-1125
Mailing Address - Fax:949-250-5841
Practice Address - Street 1:4019 WESTERLY PLACE
Practice Address - Street 2:#101
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-250-1125
Practice Address - Fax:949-250-5841
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U47736Medicare UPIN