Provider Demographics
NPI:1174821482
Name:BODYTITE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:BODYTITE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYLENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-910-4303
Mailing Address - Street 1:1603 116TH AVE NE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3009
Mailing Address - Country:US
Mailing Address - Phone:206-910-4303
Mailing Address - Fax:866-272-4303
Practice Address - Street 1:1603 116TH AVE NE
Practice Address - Street 2:SUITE 111
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3009
Practice Address - Country:US
Practice Address - Phone:206-910-4303
Practice Address - Fax:866-272-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034551261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center