Provider Demographics
NPI:1306932678
Name:BOHLMAN, ANDREW LANCE (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LANCE
Last Name:BOHLMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1279
Mailing Address - Street 2:SUITE M
Mailing Address - City:SEELEY LAKE
Mailing Address - State:MT
Mailing Address - Zip Code:59868
Mailing Address - Country:US
Mailing Address - Phone:406-677-3617
Mailing Address - Fax:
Practice Address - Street 1:3027 HWY 83
Practice Address - Street 2:SUITE M
Practice Address - City:SEELEY LAKE
Practice Address - State:MT
Practice Address - Zip Code:59868
Practice Address - Country:US
Practice Address - Phone:406-677-3617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV100555Medicare PIN