Healthcare Provider Details

I. General information

NPI: 1053596254
Provider Name (Legal Business Name): DAVID A. BODI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MILAN RD STE 4
SANDUSKY OH
44870-4143
US

IV. Provider business mailing address

1501 MILAN RD STE 4
SANDUSKY OH
44870-4143
US

V. Phone/Fax

Practice location:
  • Phone: 419-625-4990
  • Fax: 419-625-4950
Mailing address:
  • Phone: 419-625-4990
  • Fax: 419-625-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2622
License Number StateOH

VIII. Authorized Official

Name: DR. DAVID A. BODI
Title or Position: OWNER
Credential: DC
Phone: 419-625-4990