Provider Demographics
NPI:1588548572
Name:BOEDIGHEIMER, ISAAC ROMAN MOON
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:ROMAN MOON
Last Name:BOEDIGHEIMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CONSTITUTION PLZ APT 618
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-1828
Mailing Address - Country:US
Mailing Address - Phone:218-590-5332
Mailing Address - Fax:
Practice Address - Street 1:2 SPRING LN UNIT 4
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-3306
Practice Address - Country:US
Practice Address - Phone:860-470-7114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor