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NPI Code Detail

MEDICARE: MILLBOD INVESTMENTS

MEDICARE: MILLBOD INVESTMENTS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor3993OR

General Provider Information

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

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Directions to “MILLBOD INVESTMENTS ” Practice Location

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