Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 004872 | MO |
N | 111NN0400X | Neurology | 004872 | MO |
NPI | 1740330133 |
---|---|
Provider Name | Gerard William Boehmer |
First Address | Bridgeton, MO 63044-2531 |
Second Address | Bridgeton, MO 63044-2531 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 08/07/2007 |