MEDICARE: DR. MARK ROBERT BOHL DC

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	111N00000X	Chiropractor	1561012	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982693727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ROBERT BOHL DC

Provider Business Mailing Address
First Line	:	310 E MAIN ST
Second Line	:
City	:	MOUNT HOREB
State	:	WI
Zip	:	53572-2082
Country	:	US
Telephone Number	:	608-437-5000
Fax Number	:	608-437-5019

Provider Business Practice Location Address
First Line	:	310 E MAIN ST
Second Line	:
City	:	MOUNT HOREB
State	:	WI
Zip	:	53572-2082
Country	:	US
Telephone Number	:	608-437-5000
Fax Number	:	608-437-5019

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

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	11/07/2012

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