Provider Demographics
NPI:1427460427
Name:BODEN, JAMES (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
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 1:512 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3939
Mailing Address - Country:US
Mailing Address - Phone:412-316-5823
Mailing Address - Fax:
Practice Address - Street 1:512 MAINE ST
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3939
Practice Address - Country:US
Practice Address - Phone:412-316-5823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-24
Last Update Date:2014-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor