Provider Demographics
NPI:1942557715
Name:SYMTRIO CHIROPRACTIC AND SPORTS MEDICINE CLINIC, LLC
Entity Type:Organization
Organization Name:SYMTRIO CHIROPRACTIC AND SPORTS MEDICINE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BODTKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-924-1777
Mailing Address - Street 1:6125 NE CORNELL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5412
Mailing Address - Country:US
Mailing Address - Phone:503-924-1777
Mailing Address - Fax:503-924-2778
Practice Address - Street 1:6125 NE CORNELL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5412
Practice Address - Country:US
Practice Address - Phone:503-924-1777
Practice Address - Fax:503-924-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR111N00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty