Provider Demographics
NPI:1447280748
Name:RISING, BODRE M (DC)
Entity type:Individual
Prefix:DR
First Name:BODRE
Middle Name:M
Last Name:RISING
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 1:5755 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-3518
Mailing Address - Country:US
Mailing Address - Phone:409-840-9300
Mailing Address - Fax:409-842-4960
Practice Address - Street 1:5755 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-3518
Practice Address - Country:US
Practice Address - Phone:409-840-9300
Practice Address - Fax:409-842-4960
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU77177Medicare UPIN
TX8F9004Medicare PIN
TXTXB107656Medicare PIN