Provider Demographics
NPI:1568447423
Name:BOEHM, FRITZ R (DC)
Entity Type:Individual
Prefix:
First Name:FRITZ
Middle Name:R
Last Name:BOEHM
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 1:50 FILER ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-2726
Mailing Address - Country:US
Mailing Address - Phone:231-723-2221
Mailing Address - Fax:231-723-5078
Practice Address - Street 1:50 FILER ST
Practice Address - Street 2:SUITE 216
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-2726
Practice Address - Country:US
Practice Address - Phone:231-723-2221
Practice Address - Fax:231-723-5078
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI350043305OtherRAILROAD MEDICARE
MI950E150040OtherBLUE CROSS BLUE SHIELD
MI0E15004Medicare ID - Type Unspecified