Provider Demographics
NPI:1871292912
Name:BOHMAN, CAITLYNN CLAIRE DIDLICK (LAC, DACM, MACOM)
Entity type:Individual
Prefix:
First Name:CAITLYNN
Middle Name:CLAIRE DIDLICK
Last Name:BOHMAN
Suffix:
Gender:F
Credentials:LAC, DACM, MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22400 SE STARK ST STE 106
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2656
Mailing Address - Country:US
Mailing Address - Phone:503-913-2136
Mailing Address - Fax:503-825-0137
Practice Address - Street 1:22400 SE STARK ST STE 106
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2656
Practice Address - Country:US
Practice Address - Phone:503-913-2136
Practice Address - Fax:503-825-0137
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC214597171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist