Provider Demographics
NPI:1396870846
Name:BOEHM, TOD OWEN (DC, CCSP)
Entity type:Individual
Prefix:
First Name:TOD
Middle Name:OWEN
Last Name:BOEHM
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6549 LONG BEACH DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LEONARD
Mailing Address - State:MD
Mailing Address - Zip Code:20685-2541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2855 CHESAPEAKE BCH RD W
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-9530
Practice Address - Country:US
Practice Address - Phone:410-257-9762
Practice Address - Fax:410-257-9738
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSO1535111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD222997060OtherCIGNA
MDF173-0001OtherFEDERAL BCBS
MDF173-0001OtherCAREFIRST BCBS BLUECHOICE
MDF173-0001OtherCAREFIRST BCBS PREFERRED
MD2037667OtherAETNA HMO
MD222997060OtherPHCS
MD4609048OtherAETNA PPO
MD54238101OtherBCBS MD PROF RENDERING #
MDM265OtherCAREFIRST BCBS OF MD
MDM265OtherBCBS NATIONAL CAP AREA
MD177448Medicare UPIN