Healthcare Provider Details

I. General information

NPI: 1306932678
Provider Name (Legal Business Name): ANDREW LANCE BOHLMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 HWY 83 SUITE M
SEELEY LAKE MT
59868
US

IV. Provider business mailing address

P.O. BOX 1279 SUITE M
SEELEY LAKE MT
59868
US

V. Phone/Fax

Practice location:
  • Phone: 406-677-3617
  • Fax:
Mailing address:
  • Phone: 406-677-3617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1276
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: