Provider Demographics
NPI:1760539241
Name:BOHN, DAVID ALLEN (DC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:BOHN
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 1:405 FIREMANS AVE
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7014
Mailing Address - Country:US
Mailing Address - Phone:301-777-3710
Mailing Address - Fax:301-777-0436
Practice Address - Street 1:405 FIREMANS AVE
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-7014
Practice Address - Country:US
Practice Address - Phone:301-777-3710
Practice Address - Fax:301-777-0436
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01459111N00000X
MDS1459PT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001708852OtherBCBS OF WV
DC9661OtherBCBS OF NATIONAL AREA CAPITAL
DC9661OtherBCBS OF NATIONAL AREA CAPITAL
MDP00470532Medicare PIN
MD555PMedicare PIN
WV0131725000Medicaid