Provider Demographics
NPI:1578737805
Name:BOHLAND FAMILY CHIROPRACTIC CLINIC INC.
Entity Type:Organization
Organization Name:BOHLAND FAMILY CHIROPRACTIC CLINIC INC.
Other - Org Name:REIS CHIROPRACTIC CLINIC INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:BOHLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-898-9888
Mailing Address - Street 1:3939 JODECO RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-5477
Mailing Address - Country:US
Mailing Address - Phone:770-898-9888
Mailing Address - Fax:770-898-5758
Practice Address - Street 1:3939 JODECO RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5477
Practice Address - Country:US
Practice Address - Phone:770-898-9888
Practice Address - Fax:770-898-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU55500Medicare UPIN