Provider Demographics
NPI:1225391832
Name:BODYWISE OF EUNICE LLC
Entity Type:Organization
Organization Name:BODYWISE OF EUNICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:HEINEN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:337-457-8166
Mailing Address - Street 1:151 LEON AVE
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-3917
Mailing Address - Country:US
Mailing Address - Phone:337-457-8166
Mailing Address - Fax:888-371-3069
Practice Address - Street 1:151 LEON AVE
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3917
Practice Address - Country:US
Practice Address - Phone:337-457-8166
Practice Address - Fax:888-371-3069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty