Provider Demographics
NPI:1164581070
Name:BODNAR, JANET (DC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:BODNAR
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:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:MINIER
Mailing Address - State:IL
Mailing Address - Zip Code:61759-0251
Mailing Address - Country:US
Mailing Address - Phone:309-392-2096
Mailing Address - Fax:309-392-2496
Practice Address - Street 1:204 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:MINIER
Practice Address - State:IL
Practice Address - Zip Code:61759-0251
Practice Address - Country:US
Practice Address - Phone:309-392-2096
Practice Address - Fax:309-392-2496
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
038007609OtherIRS EMPLOYER TAX ID #
IL358491Medicaid
IL358491Medicaid
U52982Medicare UPIN