Provider Demographics
NPI:1073813259
Name:BODY AND MOTION CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BODY AND MOTION CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GYURINA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCWP
Authorized Official - Phone:609-654-7020
Mailing Address - Street 1:639 STOKES RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-3003
Mailing Address - Country:US
Mailing Address - Phone:609-654-7020
Mailing Address - Fax:609-654-7140
Practice Address - Street 1:639 STOKES RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-3003
Practice Address - Country:US
Practice Address - Phone:609-654-7020
Practice Address - Fax:609-654-7140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00684700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699864496OtherNPI