Provider Demographics
NPI:1720596968
Name:BODALIA, RISHI TUSHAR (DC)
Entity type:Individual
Prefix:DR
First Name:RISHI
Middle Name:TUSHAR
Last Name:BODALIA
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 1:6030 WHISPERING TREES LN
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-7352
Mailing Address - Country:US
Mailing Address - Phone:716-207-2800
Mailing Address - Fax:
Practice Address - Street 1:6030 WHISPERING TREES LN
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-7352
Practice Address - Country:US
Practice Address - Phone:716-207-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13948111NR0200X
IL038013247111NR0200X
NYX013037111NR0200X
MI2301401186111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology