Provider Demographics
NPI:1215151832
Name:BOEHLY CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:BOEHLY CHIROPRACTIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BOEHLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-889-7170
Mailing Address - Street 1:3225 CHILI AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-5442
Mailing Address - Country:US
Mailing Address - Phone:585-889-7170
Mailing Address - Fax:585-889-7178
Practice Address - Street 1:3225 CHILI AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-5442
Practice Address - Country:US
Practice Address - Phone:585-889-7170
Practice Address - Fax:585-889-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG0187432590OtherEXCELLUS BCBS GROUP ID #