Provider Demographics
NPI:1336920404
Name:BOEHLY CHIROPRACTIC NC
Entity Type:Organization
Organization Name:BOEHLY CHIROPRACTIC NC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BOEHLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-233-1942
Mailing Address - Street 1:10011 GLADWICK CT
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5256
Mailing Address - Country:US
Mailing Address - Phone:585-233-1942
Mailing Address - Fax:
Practice Address - Street 1:10011 GLADWICK CT
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5256
Practice Address - Country:US
Practice Address - Phone:585-233-1942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty