Provider Demographics
NPI:1861981748
Name:BOHANNON, KENDRA LYNN (DC)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:LYNN
Last Name:BOHANNON
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 1:15170 CHIPPENDALE AVE W STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-2769
Mailing Address - Country:US
Mailing Address - Phone:651-423-2900
Mailing Address - Fax:651-423-1330
Practice Address - Street 1:15170 CHIPPENDALE AVE W STE 200
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-2769
Practice Address - Country:US
Practice Address - Phone:651-423-2900
Practice Address - Fax:651-423-1330
Is Sole Proprietor?:No
Enumeration Date:2018-05-06
Last Update Date:2018-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor