MEDICARE: DR. CANDICE LEA BOHR

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	111N00000X	Chiropractor	092947	IA

General Provider Information

NPI Number	:	1801360656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CANDICE LEA BOHR

Provider Business Mailing Address
First Line	:	10252 ROBIN AVE
Second Line	:
City	:	CRESCO
State	:	IA
Zip	:	52136-8252
Country	:	US
Telephone Number	:	563-203-0448
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 CENTER ST
Second Line	:
City	:	LIME SPRINGS
State	:	IA
Zip	:	52155-4700
Country	:	US
Telephone Number	:	563-203-2413
Fax Number	:

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

Provider Enumeration Date	:	01/15/2019
Last Update Date	:	09/24/2020

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