Provider Demographics
NPI:1376852707
Name:BOHEEN, MATTHEW JACOB (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JACOB
Last Name:BOHEEN
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 1:1130 CROSSPOINTE LN
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2986
Mailing Address - Country:US
Mailing Address - Phone:585-872-4085
Mailing Address - Fax:
Practice Address - Street 1:1130 CROSSPOINTE LN
Practice Address - Street 2:SUITE 7
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2986
Practice Address - Country:US
Practice Address - Phone:585-872-4085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70011932111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor