Provider Demographics
NPI:1407244494
Name:BOHMAN, CAREY
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:
Last Name:BOHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 11TH AVE SW
Mailing Address - Street 2:208
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-3779
Mailing Address - Country:US
Mailing Address - Phone:763-442-4918
Mailing Address - Fax:
Practice Address - Street 1:1210 MOORE LAKE DR E
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5170
Practice Address - Country:US
Practice Address - Phone:763-571-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor