Provider Demographics
NPI:1215374285
Name:BUMHOFFER, NICOLE R (DC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:R
Last Name:BUMHOFFER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:R
Other - Last Name:SCHMIEDEKNECHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7199 KALAMAZOO AVE SE
Mailing Address - Street 2:STE 234
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316
Mailing Address - Country:US
Mailing Address - Phone:616-554-5070
Mailing Address - Fax:616-554-5465
Practice Address - Street 1:331 JUNGERMANN RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-5351
Practice Address - Country:US
Practice Address - Phone:636-928-5588
Practice Address - Fax:636-922-0071
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013015698111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor