Provider Demographics
NPI:1295998680
Name:BOHNENKAMP, MATTHEW THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:BOHNENKAMP
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 1:4217 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-3421
Mailing Address - Country:US
Mailing Address - Phone:515-460-3160
Mailing Address - Fax:515-277-0377
Practice Address - Street 1:4217 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-3421
Practice Address - Country:US
Practice Address - Phone:515-460-3160
Practice Address - Fax:515-277-0377
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor