Healthcare Provider Details

I. General information

NPI: 1528451325
Provider Name (Legal Business Name): ASHLEY BOEHLE DC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 FRANKLIN AVE
NEW HAVEN MO
63068-1426
US

IV. Provider business mailing address

22503 HOWARD BRANCH RD
WARRENTON MO
63383-6601
US

V. Phone/Fax

Practice location:
  • Phone: 573-237-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2014016038
License Number StateMO

VIII. Authorized Official

Name: DR. ASHLEY MARIE BOEHLE
Title or Position: SOLE MEMBER
Credential: DC, AT
Phone: 636-359-9155