Provider Demographics
NPI:1811064207
Name:OHMAN, BRETT JAY (DC)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:JAY
Last Name:OHMAN
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 366
Mailing Address - Street 2:
Mailing Address - City:GREYBULL
Mailing Address - State:WY
Mailing Address - Zip Code:82426-0366
Mailing Address - Country:US
Mailing Address - Phone:307-765-9634
Mailing Address - Fax:
Practice Address - Street 1:516 1ST AVE N
Practice Address - Street 2:
Practice Address - City:GREYBULL
Practice Address - State:WY
Practice Address - Zip Code:82426-2009
Practice Address - Country:US
Practice Address - Phone:307-765-9517
Practice Address - Fax:307-765-9917
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY830269981OtherEMPLOYER TAX ID NUMBER
WYW302393Medicare ID - Type UnspecifiedMEDICARE ID NUMBER