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General NPI Number Information
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NPI Number | 1720596968
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Entity Type | Individual
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Provider Name | RISHI TUSHAR BODALIA DC
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Gender | Male
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Dates
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Enumeration Date | 01/22/2018
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 6030 WHISPERING TREES LN
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City | PORT ORANGE
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State | FL
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Zip | 32128-7352
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Country | US
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Telephone | 716-207-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 6030 WHISPERING TREES LN
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City | PORT ORANGE
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State | FL
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Zip | 32128-7352
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Country | US
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Telephone | 716-207-2800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0200X
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Taxonomy Name | Radiology Chiropractor
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License Number | CH13948
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111NR0200X
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Taxonomy Name | Radiology Chiropractor
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License Number | 038013247
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 111NR0200X
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Taxonomy Name | Radiology Chiropractor
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License Number | X013037
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 111NR0200X
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Taxonomy Name | Radiology Chiropractor
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License Number | 2301401186
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License Number State | MI
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