Provider Demographics
NPI:1740442623
Name:GARRETT S BODE DC PA
Entity type:Organization
Organization Name:GARRETT S BODE DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:S
Authorized Official - Last Name:BODE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-891-1600
Mailing Address - Street 1:13694 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-9638
Mailing Address - Country:US
Mailing Address - Phone:813-891-1600
Mailing Address - Fax:813-891-1660
Practice Address - Street 1:13694 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-9638
Practice Address - Country:US
Practice Address - Phone:813-891-1600
Practice Address - Fax:813-891-1660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381566800Medicaid
FL381566800Medicaid
FLE0595AMedicare PIN