Provider Demographics
NPI:1083075055
Name:BODY BY DESIGN WELLNESS CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:BODY BY DESIGN WELLNESS CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRAVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-279-6330
Mailing Address - Street 1:500 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1901
Mailing Address - Country:US
Mailing Address - Phone:516-279-6330
Mailing Address - Fax:
Practice Address - Street 1:500 OLD COUNTRY RD
Practice Address - Street 2:SUITE 314
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1901
Practice Address - Country:US
Practice Address - Phone:516-279-6330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-011545-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty