Provider Demographics
NPI:1023198629
Name:BOECKING, NEIL ODOM (DC)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:ODOM
Last Name:BOECKING
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 W 39TH 1/2 ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-4005
Mailing Address - Country:US
Mailing Address - Phone:512-371-7478
Mailing Address - Fax:512-371-3861
Practice Address - Street 1:1015 W 39TH 1/2 ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4005
Practice Address - Country:US
Practice Address - Phone:512-371-7478
Practice Address - Fax:512-371-3861
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P0581OtherBCBS TEXAS
TX8P0581OtherBCBS TEXAS
TX8C0280Medicare ID - Type Unspecified