Healthcare Provider Details

I. General information

NPI: 1710251517
Provider Name (Legal Business Name): JOHN F BACHMAN COF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 CLEMMONS ROAD SUITE 124
CLEMMONS NC
27012-9396
US

IV. Provider business mailing address

3540 CLEMMONS ROAD SUITE 124
CLEMMONS NC
27012-9396
US

V. Phone/Fax

Practice location:
  • Phone: 336-602-1668
  • Fax: 866-211-2286
Mailing address:
  • Phone: 336-602-1668
  • Fax: 866-211-2286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberC50591
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: