Provider Demographics
NPI:1558509687
Name:BOECKENHAUER, KURT LYLE (DC)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:LYLE
Last Name:BOECKENHAUER
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 1:741 PINNACLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046
Mailing Address - Country:US
Mailing Address - Phone:402-932-8384
Mailing Address - Fax:
Practice Address - Street 1:741 PINNACLE DRIVE
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046
Practice Address - Country:US
Practice Address - Phone:402-932-8384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor