Healthcare Provider Details

I. General information

NPI: 1215374285
Provider Name (Legal Business Name): NICOLE R BUMHOFFER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE R SCHMIEDEKNECHT

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 JUNGERMANN RD
SAINT PETERS MO
63376-5351
US

IV. Provider business mailing address

7199 KALAMAZOO AVE SE STE 234
CALEDONIA MI
49316
US

V. Phone/Fax

Practice location:
  • Phone: 636-928-5588
  • Fax: 636-922-0071
Mailing address:
  • Phone: 616-554-5070
  • Fax: 616-554-5465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2013015698
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: