Healthcare Provider Details

I. General information

NPI: 1942557715
Provider Name (Legal Business Name): SYMTRIO CHIROPRACTIC AND SPORTS MEDICINE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6125 NE CORNELL RD SUITE 300
HILLSBORO OR
97124-5412
US

IV. Provider business mailing address

6125 NE CORNELL RD SUITE 300
HILLSBORO OR
97124-5412
US

V. Phone/Fax

Practice location:
  • Phone: 503-924-1777
  • Fax: 503-924-2778
Mailing address:
  • Phone: 503-924-1777
  • Fax: 503-924-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateOR

VIII. Authorized Official

Name: DR. BRIAN EDWARD BODTKER
Title or Position: OWNER
Credential: D.C
Phone: 503-924-1777