Provider Demographics
NPI:1437322682
Name:BODNAR CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:BODNAR CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BODNAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-721-0500
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1853111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01052Medicare UPIN