Provider Demographics
NPI:1326444399
Name:BODLE, BRADLEY JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JOSEPH
Last Name:BODLE
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 1:22312 MARINE VIEW DR S
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6832
Mailing Address - Country:US
Mailing Address - Phone:206-824-8464
Mailing Address - Fax:206-842-8470
Practice Address - Street 1:22312 MARINE VIEW DR S
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6832
Practice Address - Country:US
Practice Address - Phone:206-824-8464
Practice Address - Fax:206-842-8470
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60513691111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology