Healthcare Provider Details

I. General information

NPI: 1740330133
Provider Name (Legal Business Name): GERARD WILLIAM BOEHMER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3394 MCKELVEY RD SUITE 108
BRIDGETON MO
63044-2531
US

IV. Provider business mailing address

3394 MCKELVEY RD SUITE 108
BRIDGETON MO
63044-2531
US

V. Phone/Fax

Practice location:
  • Phone: 314-344-4438
  • Fax: 314-344-4438
Mailing address:
  • Phone: 314-344-4438
  • Fax: 314-344-4438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number004872
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number004872
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: