=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760539241
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ALLEN BOHN D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2007
-----------------------------------------------------
Last Update Date | 04/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 FIREMANS AVE
-----------------------------------------------------
City | LAVALE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21502-7014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-777-3710
-----------------------------------------------------
Fax | 301-777-0436
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 405 FIREMANS AVE
-----------------------------------------------------
City | LAVALE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21502-7014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-777-3710
-----------------------------------------------------
Fax | 301-777-0436
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | S01459
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | S1459PT
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------