Provider Demographics
NPI:1013012434
Name:BOOHER, GREGORY S (DC, DABCO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:BOOHER
Suffix:
Gender:M
Credentials:DC, DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-9325
Mailing Address - Country:US
Mailing Address - Phone:937-773-5452
Mailing Address - Fax:937-773-0828
Practice Address - Street 1:1760 W HIGH ST
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-9325
Practice Address - Country:US
Practice Address - Phone:937-773-5452
Practice Address - Fax:937-773-0828
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0555322Medicare ID - Type UnspecifiedMEDICARE PROVIDER #