Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00781500 | NJ |
N | 111NS0005X | Chiropractic Sports Physician | 38MC00781500 | NJ |
NPI | 1164181053 |
---|---|
Provider Name | Zachary Bohm |
First Address | Spring Lake, NJ 07762-2349 |
Second Address | Howell, NJ 07731-3335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2021 |
Last Update Date | 08/12/2021 |