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NPI Code Detail

MEDICARE: DR. ROB D BODNER D.C., LMT

MEDICARE: DR. ROB D BODNER D.C., LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor3993OR

General Provider Information

NPI Number : 1881925469
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROB D BODNER D.C., LMT
Provider Business Mailing Address
First Line : 6501 SW MACADAM AVE # 8232
Second Line :
City : PORTLAND
State : OR
Zip : 97239-3553
Country : US
Telephone Number : 503-977-0060
Fax Number : 503-977-0662
Provider Business Practice Location Address
First Line : 3735 SE DIVISION ST
Second Line :
City : PORTLAND
State : OR
Zip : 97202-1547
Country : US
Telephone Number : 503-502-1379
Fax Number : 503-488-5584
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2010
Last Update Date : 02/02/2026

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