Provider Demographics
NPI:1962673319
Name:BODETTE, THOMAS REAU (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:REAU
Last Name:BODETTE
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 1:1530 W GONZALES RD
Mailing Address - Street 2:122
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2702
Mailing Address - Country:US
Mailing Address - Phone:408-691-4722
Mailing Address - Fax:
Practice Address - Street 1:1530 W GONZALES RD
Practice Address - Street 2:122
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2702
Practice Address - Country:US
Practice Address - Phone:408-691-4722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor