Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 1188 | TN |
N | 111N00000X | Chiropractor | 2709 | WI |
Y | 111N00000X | Chiropractor | AO5801 | IA |
N | 111NN0400X | Neurology | 1999140067 | MO |
N | 111NN0400X | Neurology | 38009511 | IL |
NPI | 1417958836 |
---|---|
Provider Name | Dr. Ronnie J. Boesch |
First Address | Davenport, IA 52803-5214 |
Second Address | Davenport, IA 52803-5214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 06/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07860 | BLUE CROSS BLUE SHIELD (01) | IA |
U40236 | (02) | MO |