Provider Demographics
NPI:1003132838
Name:BODY SYSTEMS, INC.
Entity Type:Organization
Organization Name:BODY SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-363-6769
Mailing Address - Street 1:13901 YORK AVE S
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-7740
Mailing Address - Country:US
Mailing Address - Phone:612-363-6769
Mailing Address - Fax:
Practice Address - Street 1:6500 BARRIE RD
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2348
Practice Address - Country:US
Practice Address - Phone:952-562-2420
Practice Address - Fax:952-562-2421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3031261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350004024Medicaid
MN350004024Medicaid