Provider Demographics
NPI:1528193067
Name:BOHANNON CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:BOHANNON CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BOHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-321-1667
Mailing Address - Street 1:1425 W CENTRAL
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2222
Mailing Address - Country:US
Mailing Address - Phone:316-321-1667
Mailing Address - Fax:888-343-6040
Practice Address - Street 1:1425 W CENTRAL
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2222
Practice Address - Country:US
Practice Address - Phone:316-321-1667
Practice Address - Fax:316-321-1762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS14222OtherBCBS
KS014222Medicare ID - Type Unspecified