Provider Demographics
NPI:1740330133
Name:BOEHMER, GERARD WILLIAM (DC)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:WILLIAM
Last Name:BOEHMER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3394 MCKELVEY RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2531
Mailing Address - Country:US
Mailing Address - Phone:314-344-4438
Mailing Address - Fax:314-344-4438
Practice Address - Street 1:3394 MCKELVEY RD
Practice Address - Street 2:SUITE 108
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2531
Practice Address - Country:US
Practice Address - Phone:314-344-4438
Practice Address - Fax:314-344-4438
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004872111N00000X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurology