Provider Demographics
NPI:1922350248
Name:BODHI TREE LLC
Entity Type:Organization
Organization Name:BODHI TREE LLC
Other - Org Name:BODHI CHIROPRACTIC & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:ANH
Authorized Official - Last Name:ROHRBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-743-8619
Mailing Address - Street 1:2808-II E MADISON STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117
Mailing Address - Country:US
Mailing Address - Phone:206-743-8619
Mailing Address - Fax:206-743-8619
Practice Address - Street 1:2808-II E MADISON STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117
Practice Address - Country:US
Practice Address - Phone:206-743-8619
Practice Address - Fax:206-743-8619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60248152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty