NPI Code Detail JSON Logo

1568475788 NPI number — CHARLES NATHAN BODEM D C

NPI Number: 1568475788
Health Care Provider/Practitioner: CHARLES NATHAN BODEM D C

Information about “1568475788” NPI (CHARLES NATHAN BODEM D C) exists in 1568475788 in HTML format HTML  |  1568475788 in plain Text format TXT  |  1568475788 in PDF (Portable Document Format) PDF  |  1568475788 in an XML format XML  formats.

NPI Number : 1568475788 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568475788",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BODEM",
    "FirstName": "CHARLES",
    "MiddleName": "NATHAN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "307 OGDEN AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DOWNERS GROVE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60515-3142",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "630-515-0025",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "307 OGDEN AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DOWNERS GROVE",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60515-3142",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "630-515-0025",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/15/2006",
    "LastUpdateDate": "06/22/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "111N00000X",
        "TaxonomyName": "Chiropractor",
        "LicenseNumber": "038009380",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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