Provider Demographics
NPI:1538299946
Name:BODIN CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:BODIN CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BODIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-703-2694
Mailing Address - Street 1:1021 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2806
Mailing Address - Country:US
Mailing Address - Phone:405-703-2694
Mailing Address - Fax:405-703-2848
Practice Address - Street 1:1021 SW 19TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2806
Practice Address - Country:US
Practice Address - Phone:405-703-2694
Practice Address - Fax:405-703-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty