| Doctor Name: | DR. JACLYN J BOHM |
| NPI Number: | 1306005111 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPM |
| License Number: | 842 |
| Business Practice Address: | 15705 Cimarron Ave Rosemount, MN - 55068 |
| Business Phone Number: | 6513228800 |
| Business Fax Number: | 6513228840 |
| Mailing Address: | 15075 Cimarron Ave, ROSEMOUNT |
| State: | MN |
| Postal Code: | 550681635 |
| Phone Number: | 6513228800 |
| Fax Number: | 6513228840 |
| NPI Enumeration Date: | 06/06/2008 |
| NPI Last Update Date: | 07/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 842 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |