Provider Demographics
NPI:1366407470
Name:BOEHLY, CHARLES RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHARD
Last Name:BOEHLY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1226
Mailing Address - Country:US
Mailing Address - Phone:585-271-5590
Mailing Address - Fax:585-271-5593
Practice Address - Street 1:779 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1226
Practice Address - Country:US
Practice Address - Phone:585-271-5590
Practice Address - Fax:585-271-5593
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP0100009295OtherEXCELLUS BCBS
NYP0100009295OtherEXCELLUS BCBS