MEDICARE: DR. DANIEL JAY OHLMAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN1001X	Nutrition Chiropractor	2301004871	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950D15118	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1740265826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL JAY OHLMAN D.O.

Provider Business Mailing Address
First Line	:	0-699 TALLMADGE WOOD DR NW
Second Line	:	SUITE B
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-3349
Country	:	US
Telephone Number	:	616-791-9702
Fax Number	:	616-791-4661

Provider Business Practice Location Address
First Line	:	0-699 TALLMADGE WOOD DR NW
Second Line	:	SUITE B
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-3349
Country	:	US
Telephone Number	:	616-791-9702
Fax Number	:	616-791-4661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	04/24/2008

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