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General NPI Number Information
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NPI Number | 1588548572
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Entity Type | Individual
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Provider Name | ISAAC ROMAN MOON BOEDIGHEIMER
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Gender | Male
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 2 SPRING LN UNIT 4
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City | FARMINGTON
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State | CT
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Zip | 06032-3306
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Country | US
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Telephone | 860-470-7114
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Fax |
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Provider Business Mailing Address
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Address Line | 5 CONSTITUTION PLZ APT 618
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City | HARTFORD
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State | CT
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Zip | 06103-1828
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Country | US
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Telephone | 218-590-5332
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2376
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License Number State | CT
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