Provider Demographics
NPI:1568475788
Name:BODEM, CHARLES NATHAN (D C)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:NATHAN
Last Name:BODEM
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3142
Mailing Address - Country:US
Mailing Address - Phone:630-515-0025
Mailing Address - Fax:
Practice Address - Street 1:307 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3142
Practice Address - Country:US
Practice Address - Phone:630-515-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor