Healthcare Provider Details

I. General information

NPI: 1144806894
Provider Name (Legal Business Name): CHRISTIAN BOEKWEG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 300 N
ROOSEVELT UT
84066-2336
US

IV. Provider business mailing address

1460 N MAIN ST UNIT 1B
SPANISH FORK UT
84660-1016
US

V. Phone/Fax

Practice location:
  • Phone: 435-722-4691
  • Fax:
Mailing address:
  • Phone: 385-518-0403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number011749
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9054
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCL0767
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS22568
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13958007-1204
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberU0557
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: