Provider Demographics
NPI:1316085798
Name:BOHAC, KENT RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:RICHARD
Last Name:BOHAC
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 1:16835 Q ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-1501
Mailing Address - Country:US
Mailing Address - Phone:402-896-1996
Mailing Address - Fax:
Practice Address - Street 1:16835 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-1501
Practice Address - Country:US
Practice Address - Phone:402-896-1996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor