11D2146258 CLIA NUMBER - BOHLAND FAMILY & SPORTS CHIROPRACTIC CLINIC

Laboratory Demographics

CLIA Number: 11D2146258

Facility Name: BOHLAND FAMILY & SPORTS CHIROPRACTIC CLINIC

Facility Address:
3939 JODECO ROD
MCDONOUGH, GA
ZIP 30253
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Facility Phone Number: 770 898-9888

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1578737805

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

CLIA Record

Field Name	Field Value
CLIA Number	11D2146258
LAB Type	Practitioner Other
Facility Name	BOHLAND FAMILY & SPORTS CHIROPRACTIC CLINIC
Street	3939 JODECO ROD
City	MCDONOUGH
State	GA
ZIP	30253
Phone	770 898-9888
CertificateType	4
CertificateEffectiveDate	3/27/2024
CertificateExpirationDate	3/26/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024