Provider Demographics
NPI:1225314545
Name:BODY ELEMENTS CORP
Entity Type:Organization
Organization Name:BODY ELEMENTS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JD
Authorized Official - Middle Name:
Authorized Official - Last Name:FARLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-657-7463
Mailing Address - Street 1:2323 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 105C
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2000
Mailing Address - Country:US
Mailing Address - Phone:770-657-7463
Mailing Address - Fax:
Practice Address - Street 1:2323 SHALLOWFORD RD
Practice Address - Street 2:SUITE 105C
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2000
Practice Address - Country:US
Practice Address - Phone:770-657-7463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty