Provider Demographics
NPI:1851442339
Name:BOEHMER, ALICYN MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ALICYN
Middle Name:MARIE
Last Name:BOEHMER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 FORUM BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5409
Mailing Address - Country:US
Mailing Address - Phone:573-445-4000
Mailing Address - Fax:573-447-3336
Practice Address - Street 1:1608 CHAPEL HILL RD STE D
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5464
Practice Address - Country:US
Practice Address - Phone:573-445-4000
Practice Address - Fax:573-447-3336
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005003663111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO198295OtherBLUE CROSS BLUE SHIELD
MO671564OtherUNITED HEALTH CARE
MO198295OtherBLUE CROSS BLUE SHIELD