Provider Demographics
NPI:1366555120
Name:BOHN, ROGER (DC)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:BOHN
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 1:27970 CROWN LAKE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4255
Mailing Address - Country:US
Mailing Address - Phone:239-947-3330
Mailing Address - Fax:239-947-9493
Practice Address - Street 1:27970 CROWN LAKE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4255
Practice Address - Country:US
Practice Address - Phone:239-947-3330
Practice Address - Fax:239-947-9493
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH00004690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-2534316OtherFEDERAL TAX ID
FL70580Medicare ID - Type Unspecified
FLT85460Medicare UPIN