Provider Demographics
NPI:1215912969
Name:BOEHM, HEIDI L (DC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:BOEHM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 FILER ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-2726
Mailing Address - Country:US
Mailing Address - Phone:231-723-2221
Mailing Address - Fax:231-723-5078
Practice Address - Street 1:50 FILER ST
Practice Address - Street 2:SUITE 216
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-2726
Practice Address - Country:US
Practice Address - Phone:231-723-2221
Practice Address - Fax:231-723-5078
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E110200OtherBCBS OF MICHIGAN
MI202052157OtherTAX ID
MI202052157OtherTAX ID