Provider Demographics
NPI:1275220386
Name:BOHMAN, NIKOLAS TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:NIKOLAS
Middle Name:TODD
Last Name:BOHMAN
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 1:3537 SHADY LANE CIR
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-7940
Mailing Address - Country:US
Mailing Address - Phone:952-693-8588
Mailing Address - Fax:
Practice Address - Street 1:29 N 1ST STREET
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-5640
Practice Address - Country:US
Practice Address - Phone:218-590-3007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor