Provider Demographics
NPI:1477737351
Name:ROGER A BOHN DC PA
Entity Type:Organization
Organization Name:ROGER A BOHN DC PA
Other - Org Name:BOHN CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-947-3330
Mailing Address - Street 1:27970 CROWN LAKE BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4255
Mailing Address - Country:US
Mailing Address - Phone:239-947-3330
Mailing Address - Fax:239-947-9493
Practice Address - Street 1:27970 CROWN LAKE BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4255
Practice Address - Country:US
Practice Address - Phone:239-947-3330
Practice Address - Fax:239-947-9493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH00004690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70580Medicare UPIN