Provider Demographics
NPI:1669450409
Name:BOECK, THOMAS PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PAUL
Last Name:BOECK
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 1:1910 S GLENBURNIE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5298
Mailing Address - Country:US
Mailing Address - Phone:252-634-3111
Mailing Address - Fax:252-634-3040
Practice Address - Street 1:1910 S GLENBURNIE RD
Practice Address - Street 2:SUITE A
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5298
Practice Address - Country:US
Practice Address - Phone:252-634-3111
Practice Address - Fax:252-634-3040
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908931NMedicaid
NC2451570AMedicare ID - Type Unspecified
NCU60813Medicare UPIN