MEDICARE: MR. JOHN F BACHMAN COF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225000000X	Orthotic Fitter	C50591	NC

General Provider Information

NPI Number	:	1710251517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN F BACHMAN COF

Provider Business Mailing Address
First Line	:	3540 CLEMMONS ROAD
Second Line	:	SUITE 124
City	:	CLEMMONS
State	:	NC
Zip	:	27012-9396
Country	:	US
Telephone Number	:	336-602-1668
Fax Number	:	866-211-2286

Provider Business Practice Location Address
First Line	:	3540 CLEMMONS ROAD
Second Line	:	SUITE 124
City	:	CLEMMONS
State	:	NC
Zip	:	27012-9396
Country	:	US
Telephone Number	:	336-602-1668
Fax Number	:	866-211-2286

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2012
Last Update Date	:	03/20/2013

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