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General NPI Number Information
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NPI Number | 1790138972
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Entity Type | Individual
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Provider Name | TIMOTHY MICHAEL BODILY D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2016
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 2524 BURNSED BLVD
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City | THE VILLAGES
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State | FL
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Zip | 32163-2704
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Country | US
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Telephone | 352-750-6325
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Fax | 352-399-5741
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Provider Business Mailing Address
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Address Line | 6166 W GULF TO LAKE HWY
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-7558
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Country | US
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Telephone | 352-795-8911
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH 11843
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License Number State | FL
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