Provider Demographics
NPI:1003213893
Name:BODY CENTER KALAMAZOO
Entity Type:Organization
Organization Name:BODY CENTER KALAMAZOO
Other - Org Name:THE BODY CENTER.US
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-836-1271
Mailing Address - Street 1:2042 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-3041
Mailing Address - Country:US
Mailing Address - Phone:616-836-1271
Mailing Address - Fax:
Practice Address - Street 1:2042 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-3041
Practice Address - Country:US
Practice Address - Phone:616-836-1271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-23
Last Update Date:2014-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000710174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty