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General NPI Number Information
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NPI Number | 1710005541
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Entity Type | Organization
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Legal Business Name | BODZIN CHIROPRACTIC PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6030 SANTO RD D
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City | SAN DIEGO
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State | CA
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Zip | 92124-1196
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Country | US
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Telephone | 858-541-0505
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Fax | 858-541-0527
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Provider Business Mailing Address
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Address Line | 6030 SANTO RD D
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City | SAN DIEGO
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State | CA
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Zip | 92124-1196
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Country | US
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Telephone | 858-541-0505
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Fax | 858-541-0527
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MILES I BODZIN
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Credential | DC
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Telephone | 858-541-0505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC29627
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC23213
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License Number State | CA
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