Provider Demographics
NPI:1043572076
Name:TOTAL BODY HEALTHCARE, INC.
Entity Type:Organization
Organization Name:TOTAL BODY HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHYLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-855-8845
Mailing Address - Street 1:1057 E IMPERIAL HWY
Mailing Address - Street 2:SUITE 614
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-1717
Mailing Address - Country:US
Mailing Address - Phone:714-293-4060
Mailing Address - Fax:714-577-9020
Practice Address - Street 1:24401 MUIRLANDS BLVD STE C
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3949
Practice Address - Country:US
Practice Address - Phone:949-855-8845
Practice Address - Fax:949-855-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81865207Q00000X, 207QS0010X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty