1851442339 NPI number — DR. ALICYN MARIE BOEHMER D.C.

Table of content: (NPI 1831384205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851442339 NPI number — DR. ALICYN MARIE BOEHMER D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOEHMER
Provider First Name:
ALICYN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851442339
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2216 FORUM BLVD
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65203-5409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-445-4000
Provider Business Mailing Address Fax Number:
573-447-3336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1608 CHAPEL HILL RD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65203-5464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-445-4000
Provider Business Practice Location Address Fax Number:
573-447-3336
Provider Enumeration Date:
01/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2005003663 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 198295 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 671564 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".