Provider Demographics
NPI:1750475968
Name:BODNAR, ANNA MARIE (DC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:BODNAR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 SW BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545
Mailing Address - Country:US
Mailing Address - Phone:912-530-7977
Mailing Address - Fax:912-530-7978
Practice Address - Street 1:156 SW BROAD STREET
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545
Practice Address - Country:US
Practice Address - Phone:912-530-7977
Practice Address - Fax:912-530-7978
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC8072OtherPALMETTO GBA
GA930925OtherBCBS
DC8072OtherPALMETTO GBA
U69026Medicare UPIN