Provider Demographics
NPI:1053460493
Name:BODY LOGIC INCORPORATED
Entity Type:Organization
Organization Name:BODY LOGIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-229-0698
Mailing Address - Street 1:2050 RUSSETT WAY
Mailing Address - Street 2:SUITE 137
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-2112
Mailing Address - Country:US
Mailing Address - Phone:877-427-9242
Mailing Address - Fax:
Practice Address - Street 1:2109 WILLIAMSBURG CT N
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5044
Practice Address - Country:US
Practice Address - Phone:281-229-0698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4863111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty