MEDICARE: JUSTIN WAKE BODE DC

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
1	111N00000X	Chiropractor	2433	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962474122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN WAKE BODE DC

Provider Business Mailing Address
First Line	:	300 MAGNOLIA SQUARE CT
Second Line	:
City	:	ABERDEEN
State	:	NC
Zip	:	28315-2227
Country	:	US
Telephone Number	:	910-695-1500
Fax Number	:	910-695-1505

Provider Business Practice Location Address
First Line	:	300 MAGNOLIA SQUARE CT
Second Line	:
City	:	ABERDEEN
State	:	NC
Zip	:	28315-2227
Country	:	US
Telephone Number	:	910-695-1500
Fax Number	:	910-695-1505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	07/08/2007

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Directions to “ JUSTIN WAKE BODE DC” Practice Location

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