NPIMap

Organization Active NPI

Symtrio Chiropractic and Sports Medicine Clinic, LLC

  • Chiropractor
  • Hillsboro, OR
National Provider Identifier
1942557715
Registry record updated Aug 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
SYMTRIO CHIROPRACTIC AND SPORTS MEDICINE CLINIC, LLC
Practice address
6125 NE Cornell Rd
Suite 300
Hillsboro, OR 97124-5412
Phone
(503) 924-1777
Fax
(503) 924-2778
NPI assigned
Aug 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Brian Edward Bodtker, D.CNPI 1720358054
Title
Owner
Phone
(503) 924-1777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X OR Primary
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X OR

Addresses

Primary practice location

6125 NE Cornell Rd
Suite 300
Hillsboro, OR 97124-5412

Mailing address

6125 NE Cornell Rd
Suite 300
Hillsboro, OR 97124-5412
Phone (503) 924-1777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190627002612 OR Part B Supplier - Clinic/Group Practice 4880928662 Receives reassigned benefits from 2 practitioners
Practice locations: Hillsboro, OR

National Provider Directory

National Provider Directory

Locations

1323 NE Orenco Station Pkwy
Ste 300
Hillsboro, OR 97124
Phone (503) 924-1777

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344556800000",
    "number": "1942557715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6125 NE CORNELL RD",
            "address_2": "SUITE 300",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971245412",
            "telephone_number": "503-924-1777",
            "fax_number": "503-924-2778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6125 NE CORNELL RD",
            "address_2": "SUITE 300",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971245412",
            "telephone_number": "503-924-1777",
            "fax_number": "503-924-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYMTRIO CHIROPRACTIC AND SPORTS MEDICINE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-10",
        "last_updated": "2012-08-10",
        "status": "A",
        "authorized_official_last_name": "BODTKER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-924-1777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "OR",
            "license": null,
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hillsboro, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.