Provider Demographics
NPI:1376758995
Name:BODNER CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:BODNER CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRSEDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHILA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BODNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-368-8525
Mailing Address - Street 1:1675 BROADWAY ST
Mailing Address - Street 2:A
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-2401
Mailing Address - Country:US
Mailing Address - Phone:650-368-8525
Mailing Address - Fax:650-368-1370
Practice Address - Street 1:1675 BOADWAY
Practice Address - Street 2:A
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063
Practice Address - Country:US
Practice Address - Phone:650-368-8525
Practice Address - Fax:650-368-1370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty