Provider Demographics
NPI:1487093209
Name:BOECKER, KENNETH (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:BOECKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5408 DISCOVERY PARK BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2893
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5408 DISCOVERY PARK BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2893
Practice Address - Country:US
Practice Address - Phone:757-220-8552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-15
Last Update Date:2013-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor