Provider Demographics
NPI:1689626129
Name:BOHANNON, CYNTHIA L (DC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:BOHANNON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 UNIVERSITY BLVD W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2013
Mailing Address - Country:US
Mailing Address - Phone:904-733-6665
Mailing Address - Fax:904-739-9117
Practice Address - Street 1:1901 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2013
Practice Address - Country:US
Practice Address - Phone:904-733-6665
Practice Address - Fax:904-739-9117
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH5084OtherLIC # FROM STATE OF FL
FL70807Medicare ID - Type Unspecified