Provider Demographics
NPI:1528505096
Name:BOHNENBLUST, ADAM (DC)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:BOHNENBLUST
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 1:411 N WASHINGTON AVE STE 2200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1740
Mailing Address - Country:US
Mailing Address - Phone:469-334-0624
Mailing Address - Fax:
Practice Address - Street 1:411 N WASHINGTON AVE STE 2200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:469-334-0624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152730OtherTEXAS BOARD OF CHIROPRACTIC EXAMINERS