Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1536 | NE |
NPI | 1003054131 |
---|---|
Provider Name | Dr. Tonya Louise Boeckenhauer |
First Address | Papillion, NE 68046 |
Second Address | Papillion, NE 68046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2009 |
Last Update Date | 28/01/2009 |