Provider Demographics
NPI:1316281033
Name:BOHN, AMANDA JO (DC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:BOHN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 11TH ST S
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-5032
Mailing Address - Country:US
Mailing Address - Phone:970-775-3852
Mailing Address - Fax:
Practice Address - Street 1:440 11TH ST S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-5032
Practice Address - Country:US
Practice Address - Phone:970-775-3852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0006928111N00000X
WI4959-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor