Provider Demographics
NPI:1730108697
Name:BODIN, TYLER RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:RAY
Last Name:BODIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12445 ALAMEDA TRACE CIR
Mailing Address - Street 2:#312
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-6390
Mailing Address - Country:US
Mailing Address - Phone:512-297-2231
Mailing Address - Fax:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor