Provider Demographics
NPI:1366594335
Name:BODEN, RICHARD J (DC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:BODEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 GRANGE DR
Mailing Address - Street 2:
Mailing Address - City:APOLLO
Mailing Address - State:PA
Mailing Address - Zip Code:15613-9608
Mailing Address - Country:US
Mailing Address - Phone:724-727-2050
Mailing Address - Fax:
Practice Address - Street 1:601 GRANGE DR
Practice Address - Street 2:
Practice Address - City:APOLLO
Practice Address - State:PA
Practice Address - Zip Code:15613-9608
Practice Address - Country:US
Practice Address - Phone:724-727-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1930816OtherHIGHMARK