Active NPI
Mandy Ann Boyle, DC
- Nutrition Chiropractor
- San Luis Obispo, CA
National Provider Identifier
1316530181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutrition Chiropractor
- License
- DC36033
- Practice address
- 1551 Bishop St # C-320
San Luis Obispo, CA 93401-4635 - Phone
- (805) 439-2828
- Fax
- (805) 439-2839
- NPI assigned
- Feb 12, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 14701 | TX | |
| Nutrition Chiropractor | 111NN1001X | DC36033 | CA | Primary |
Addresses
Primary practice location
1551 Bishop St # C-320
San Luis Obispo, CA 93401-4635
Mailing address
110 Deer Trail Cir
Arroyo Grande, CA 93420-1315
Phone (281) 352-4748
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 87-3154296 | Other | CA | OUT OF NETWORK |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | https://omniwellness.janeapp.com/login | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14701 | TX | MD | Chiropractor |
| DC36033 | CA | MD | Nutrition Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638921600000",
"number": "1316530181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 DEER TRAIL CIR",
"city": "ARROYO GRANDE",
"state": "CA",
"postal_code": "934201315",
"telephone_number": "281-352-4748",
"fax_number": "805-439-2839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1551 BISHOP ST # C-320",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934014635",
"telephone_number": "805-439-2828",
"fax_number": "805-439-2839"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOYLE",
"first_name": "MANDY",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-12",
"last_updated": "2021-12-08",
"certification_date": "2021-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "TX",
"license": "14701",
"primary": false
},
{
"code": "111NN1001X",
"taxonomy_group": "",
"desc": "Chiropractor, Nutrition",
"state": "CA",
"license": "DC36033",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OUT OF NETWORK",
"identifier": "87-3154296",
"state": "CA"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "https://omniwellness.janeapp.com/login",
"affiliation": "N",
"endpointDescription": "JaneApp",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Interactive Online",
"address_1": "1551 Bishop St # C-320",
"city": "San Luis Obispo",
"state": "CA",
"country_code": "US",
"postal_code": "934014635",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in San Luis Obispo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.