Provider Demographics
NPI:1528196359
Name:BODFISH, GUY (DAOM, LAC)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:
Last Name:BODFISH
Suffix:
Gender:M
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 W SUSSEX AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6533
Mailing Address - Country:US
Mailing Address - Phone:406-240-4545
Mailing Address - Fax:
Practice Address - Street 1:1905 W SUSSEX AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6533
Practice Address - Country:US
Practice Address - Phone:406-240-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT124171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist