Provider Demographics
NPI:1740265826
Name:OHLMAN, DANIEL JAY (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAY
Last Name:OHLMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0-699 TALLMADGE WOOD DR NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-3349
Mailing Address - Country:US
Mailing Address - Phone:616-791-9702
Mailing Address - Fax:616-791-4661
Practice Address - Street 1:0-699 TALLMADGE WOOD DR NW
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-3349
Practice Address - Country:US
Practice Address - Phone:616-791-9702
Practice Address - Fax:616-791-4661
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-12
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004871111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950D15118OtherBLUE CROSS BLUE SHIELD
MIP32480001Medicare PIN