Healthcare Provider Details

I. General information

NPI: 1740265826
Provider Name (Legal Business Name): DANIEL JAY OHLMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

0-699 TALLMADGE WOOD DR NW SUITE B
GRAND RAPIDS MI
49534-3349
US

IV. Provider business mailing address

0-699 TALLMADGE WOOD DR NW SUITE B
GRAND RAPIDS MI
49534-3349
US

V. Phone/Fax

Practice location:
  • Phone: 616-791-9702
  • Fax: 616-791-4661
Mailing address:
  • Phone: 616-791-9702
  • Fax: 616-791-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2301004871
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: