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General NPI Number Information
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NPI Number | 1871292912
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Entity Type | Individual
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Provider Name | CAITLYNN CLAIRE DIDLICK BOHMAN LAC, DACM, MACOM
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Gender | Female
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 22400 SE STARK ST STE 106
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City | GRESHAM
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State | OR
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Zip | 97030-2656
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Country | US
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Telephone | 503-913-2136
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Fax | 503-825-0137
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Provider Business Mailing Address
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Address Line | 22400 SE STARK ST STE 106
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City | GRESHAM
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State | OR
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Zip | 97030-2656
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Country | US
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Telephone | 503-913-2136
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Fax | 503-825-0137
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC214597
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License Number State | OR
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