Provider Demographics
NPI:1801881693
Name:BOEHMER, JAMES DONALD (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DONALD
Last Name:BOEHMER
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 1:12571 HESPERIA RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5847
Mailing Address - Country:US
Mailing Address - Phone:760-241-2000
Mailing Address - Fax:760-241-2100
Practice Address - Street 1:12571 HESPERIA RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5847
Practice Address - Country:US
Practice Address - Phone:760-241-2000
Practice Address - Fax:760-241-2100
Is Sole Proprietor?:No
Enumeration Date:2005-09-17
Last Update Date:2011-02-01
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
CA19386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU22592Medicare UPIN
CA0193680Medicare ID - Type Unspecified