Provider Demographics
NPI:1962774497
Name:BOECHLER, RYAN KEITH (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:KEITH
Last Name:BOECHLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:26520 BARNES ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-3523
Mailing Address - Country:US
Mailing Address - Phone:586-944-5042
Mailing Address - Fax:248-771-3293
Practice Address - Street 1:37140 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3535
Practice Address - Country:US
Practice Address - Phone:248-952-8051
Practice Address - Fax:586-979-3276
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI2301009920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor