Provider Demographics
NPI:1891847208
Name:BODE CHIROPRACTIC CENTER, INC
Entity Type:Organization
Organization Name:BODE CHIROPRACTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BODE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-695-1500
Mailing Address - Street 1:300 MAGNOLIA SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-2227
Mailing Address - Country:US
Mailing Address - Phone:910-695-1500
Mailing Address - Fax:910-695-1505
Practice Address - Street 1:300 MAGNOLIA SQUARE CT
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2227
Practice Address - Country:US
Practice Address - Phone:910-695-1500
Practice Address - Fax:910-695-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890829MMedicaid
NCU68512Medicare UPIN
NC890829MMedicaid