Provider Demographics
NPI:1720310386
Name:BODKIN, JAMES ROBERT (BS,DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:BODKIN
Suffix:
Gender:M
Credentials:BS,DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6102 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1684
Mailing Address - Country:US
Mailing Address - Phone:423-475-6438
Mailing Address - Fax:
Practice Address - Street 1:6102 SHALLOWFORD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1684
Practice Address - Country:US
Practice Address - Phone:423-475-6438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor