Provider Demographics
NPI:1043491889
Name:BODILY-GOODMANSEN, CORENE KAY (DC)
Entity type:Individual
Prefix:DR
First Name:CORENE
Middle Name:KAY
Last Name:BODILY-GOODMANSEN
Suffix:
Gender:F
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:PO BOX 2421
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-2421
Mailing Address - Country:US
Mailing Address - Phone:253-347-0102
Mailing Address - Fax:253-327-1296
Practice Address - Street 1:17147 VASHON HWY SW STE 111
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-4603
Practice Address - Country:US
Practice Address - Phone:253-970-5077
Practice Address - Fax:253-327-1296
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor