MEDICARE: MR. IAN JOSEPH BOEHM JR. DC

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
1	111N00000X	Chiropractor	1269	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467405134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IAN JOSEPH BOEHM JR. DC

Provider Business Mailing Address
First Line	:	9 BOSTON ST STE 1
Second Line	:
City	:	LYNN
State	:	MA
Zip	:	01904-2536
Country	:	US
Telephone Number	:	781-599-3631
Fax Number	:	781-599-2285

Provider Business Practice Location Address
First Line	:	9 BOSTON ST STE 1
Second Line	:
City	:	LYNN
State	:	MA
Zip	:	01904-2536
Country	:	US
Telephone Number	:	781-599-3631
Fax Number	:	781-599-2285

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/28/2020

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