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General NPI Number Information
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NPI Number | 1942557715
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Entity Type | Organization
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Legal Business Name | SYMTRIO CHIROPRACTIC AND SPORTS MEDICINE CLINIC, LLC
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Dates
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Enumeration Date | 08/10/2012
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Last Update Date | 08/10/2012
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Provider Practice Location Address
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Address Line | 6125 NE CORNELL RD SUITE 300
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City | HILLSBORO
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State | OR
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Zip | 97124-5412
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Country | US
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Telephone | 503-924-1777
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Fax | 503-924-2778
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Provider Business Mailing Address
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Address Line | 6125 NE CORNELL RD SUITE 300
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City | HILLSBORO
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State | OR
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Zip | 97124-5412
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Country | US
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Telephone | 503-924-1777
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Fax | 503-924-2778
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN EDWARD BODTKER
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Credential | D.C
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Telephone | 503-924-1777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State | OR
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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 |
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License Number State | OR
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