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General NPI Number Information
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NPI Number | 1710224639
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Entity Type | Organization
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Legal Business Name | MILLBOD INVESTMENTS
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Dates
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Enumeration Date | 01/11/2013
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Last Update Date | 01/11/2013
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Provider Practice Location Address
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Address Line | 3735 SE DIVISION ST
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City | PORTLAND
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State | OR
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Zip | 97202-1547
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Country | US
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Telephone | 503-502-1379
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Fax | 503-488-5584
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Provider Business Mailing Address
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Address Line | 3735 SE DIVISION ST
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City | PORTLAND
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State | OR
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Zip | 97202-1547
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Country | US
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Telephone | 503-502-1379
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. ROBERT BODNER
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Credential | DC, LMT
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Telephone | 503-614-9561
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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 | 3993
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License Number State | OR
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