Provider Demographics
NPI:1619050325
Name:BOHNEN, GARY ALBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALBERT
Last Name:BOHNEN
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:PO BOX 337
Mailing Address - Street 2:BOHNEN CHIROPRACTIC CENTER PA
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040
Mailing Address - Country:US
Mailing Address - Phone:763-444-5597
Mailing Address - Fax:763-444-5598
Practice Address - Street 1:401 EAST DUAL BLVD
Practice Address - Street 2:BOHNEN CHIROPRACTIC CENTER PA
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040
Practice Address - Country:US
Practice Address - Phone:763-444-5597
Practice Address - Fax:763-444-5598
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1634111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN56040BOOtherBLUE CROSS BLUE SHIELD
MN230103OtherCHIROCARE OF MINNESOTA
T65328Medicare UPIN