Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | SO1535 | MD |
N | 111NS0005X | Chiropractic Sports Physician | SO1535 | MD |
NPI | 1396870846 |
---|---|
Provider Name | Tod Owen Boehm |
First Address | Saint Leonard, MD 20685-2541 |
Second Address | Dunkirk, MD 20754-9530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 28/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
177448 | (02) | MD |
2037667 | AETNA HMO (01) | MD |
222997060 | CIGNA (01) | MD |
222997060 | PHCS (01) | MD |
4609048 | AETNA PPO (01) | MD |
54238101 | BCBS MD PROF RENDERING # (01) | MD |
F173-0001 | CAREFIRST BCBS BLUECHOICE (01) | MD |
F173-0001 | CAREFIRST BCBS PREFERRED (01) | MD |
F173-0001 | FEDERAL BCBS (01) | MD |
M265 | BCBS NATIONAL CAP AREA (01) | MD |
M265 | CAREFIRST BCBS OF MD (01) | MD |