Tyler Ray Bodin, D.C.
Individual provider Active NPI Chiropractor · Moore, OK
NPI 1730108697 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1730108697
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 3813 (OK)
- Practice address
- 1021 SW. 19TH St.
Moore, OK 73160-2806 - Phone
- (405) 703-2694
- Fax
- (405) 703-2848
- NPI assigned
- Jul 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Cleveland Chiropractic College - Kansas City, 2005
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
705 SW 119TH St
Oklahoma City, OK 73170-6067
Phone (405) 703-2694
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090326000526 | OK | Practitioner - Chiropractic | 1951468479 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bodin Chiropractic PLLC | Chiropractor | Current |
Accepting new patients |
| Summit Medical Center | Past | Accepting new patients |
Locations
1021 SW 19th St
Moore, OK 73160
Phone (405) 703-2694
705 SW 119th St
Oklahoma City, OK 73170
Phone (405) 703-2694
821 SW 119th St
Oklahoma City, OK 73170
Phone (405) 703-2694
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3813 | OK | Yes |
Addresses
Primary practice location
1021 SW. 19TH St.
Moore, OK 73160-2806
Mailing address
12445 Alameda Trace Cir
#312
Austin, TX 78727-6390
Phone (512) 297-2231
Other providers in Moore, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.