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NPI Code Detail

MEDICARE: MARTHA K BOELTER D.C.

MEDICARE: MARTHA K BOELTER D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor005822MO

General Provider Information

NPI Number : 1427124254
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA K BOELTER D.C.
Provider Business Mailing Address
First Line : 4444 TELEGRAPH RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63129-3316
Country : US
Telephone Number : 314-416-4100
Fax Number : 314-416-4141
Provider Business Practice Location Address
First Line : 4444 TELEGRAPH RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63129-3316
Country : US
Telephone Number : 314-416-4100
Fax Number : 314-416-4141
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2006
Last Update Date : 09/13/2011

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