Provider Demographics
NPI:1194741843
Name:BOERNER, MICHAEL D (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:BOERNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10465 MELODY DRIVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234
Mailing Address - Country:US
Mailing Address - Phone:303-335-9306
Mailing Address - Fax:866-459-2576
Practice Address - Street 1:10465 MELODY DRIVE
Practice Address - Street 2:SUITE 303
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4125
Practice Address - Country:US
Practice Address - Phone:303-335-9306
Practice Address - Fax:866-459-2576
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COEL.2782841111NR0400X
COCHR.0005699111NS0005X, 111N00000X
COAC.2786126171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11554701OtherCAQH