Individual
JOHN JASON BOEHM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, CNS, MMC
Contact information
Practice address
4364 N. KENMORE AVE, SUITE 1, CHICAGO, IL 60613-1394
(917) 292-1100
Mailing address
4364 N. KENMORE AVE, SUITE 1, CHICAGO, IL 60613-1394
(917) 292-1100
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
Other
Enumeration date
07/13/2011
Last updated
07/13/2011
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