Provider Demographics
NPI:1982696142
Name:BODZIN, MILES IVAN (DC)
Entity type:Individual
Prefix:DR
First Name:MILES
Middle Name:IVAN
Last Name:BODZIN
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 SANTO RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-1196
Mailing Address - Country:US
Mailing Address - Phone:858-541-0505
Mailing Address - Fax:858-541-0527
Practice Address - Street 1:6030 SANTO RD
Practice Address - Street 2:SUITE D
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-1196
Practice Address - Country:US
Practice Address - Phone:858-541-0505
Practice Address - Fax:858-541-0527
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23213Medicare ID - Type Unspecified
U59786Medicare UPIN