Provider Demographics
NPI:1649390014
Name:BOER, ROBERT WARREN (DC, PA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WARREN
Last Name:BOER
Suffix:
Gender:M
Credentials:DC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 N LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-1635
Mailing Address - Country:US
Mailing Address - Phone:630-966-2637
Mailing Address - Fax:630-966-1611
Practice Address - Street 1:23 N LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1635
Practice Address - Country:US
Practice Address - Phone:630-966-2637
Practice Address - Fax:630-966-1611
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007485111N00000X
IL085002500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4532434OtherBCBS
IL215546004Medicare PIN
IL4532434OtherBCBS
U5277Medicare UPIN