Provider Demographics
NPI:1225308125
Name:BODOH, JAMES TIMOTHY (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:TIMOTHY
Last Name:BODOH
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 1:831 CRITTER CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8674
Mailing Address - Country:US
Mailing Address - Phone:608-781-2273
Mailing Address - Fax:608-781-2727
Practice Address - Street 1:831 CRITTER CT
Practice Address - Street 2:SUITE 100
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8674
Practice Address - Country:US
Practice Address - Phone:608-781-2273
Practice Address - Fax:608-781-2727
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4813-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor