Provider Demographics
NPI:1881875334
Name:BOEHMER CHIROPRACTIC AND ACUPUNCTURE PC
Entity type:Organization
Organization Name:BOEHMER CHIROPRACTIC AND ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOEHMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-445-4000
Mailing Address - Street 1:2216 FORUM BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5403
Mailing Address - Country:US
Mailing Address - Phone:573-445-4000
Mailing Address - Fax:573-447-3336
Practice Address - Street 1:2216 FORUM BLVD
Practice Address - Street 2:SUITE 102
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005003663111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000014890Medicare PIN