Provider Demographics
NPI:1710224639
Name:MILLBOD INVESTMENTS
Entity Type:Organization
Organization Name:MILLBOD INVESTMENTS
Other - Org Name:RIDGELINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BODNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LMT
Authorized Official - Phone:503-614-9561
Mailing Address - Street 1:3735 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1547
Mailing Address - Country:US
Mailing Address - Phone:503-502-1379
Mailing Address - Fax:
Practice Address - Street 1:3735 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1547
Practice Address - Country:US
Practice Address - Phone:503-502-1379
Practice Address - Fax:503-488-5584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty