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General NPI Number Information
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NPI Number | 1619346889
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Entity Type | Organization
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Legal Business Name | MICHAEL W BOHRNSEN LLC
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 09/17/2015
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Provider Practice Location Address
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Address Line | 15312 E SPRAGUE AVE # 23
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City | SPOKANE VALLEY
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State | WA
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Zip | 99037-8861
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Country | US
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Telephone | 509-828-0538
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Fax |
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Provider Business Mailing Address
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Address Line | 15312 E SPRAGUE AVE # 23
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City | SPOKANE VALLEY
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State | WA
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Zip | 99037-8861
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Country | US
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Telephone | 509-828-0538
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL BOHRNSEN
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Credential | DC
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Telephone | 509-828-0538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CH60485899
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License Number State | WA
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