Provider Demographics
NPI:1184680514
Name:BODNAR, BRIAN JOHN (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOHN
Last Name:BODNAR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6969 RICHMOND HWY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-1839
Mailing Address - Country:US
Mailing Address - Phone:703-721-0500
Mailing Address - Fax:703-721-0534
Practice Address - Street 1:6969 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-1839
Practice Address - Country:US
Practice Address - Phone:703-721-0500
Practice Address - Fax:703-721-0534
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1853111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU87091Medicare UPIN