Provider Demographics
NPI:1235444647
Name:BODY WORKS CHIROPRACTIC AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:BODY WORKS CHIROPRACTIC AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-988-0988
Mailing Address - Street 1:68 GLOBAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4628
Mailing Address - Country:US
Mailing Address - Phone:864-644-2700
Mailing Address - Fax:864-644-2709
Practice Address - Street 1:2330 WINDY HILL RD SE
Practice Address - Street 2:STE. 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8602
Practice Address - Country:US
Practice Address - Phone:770-988-0988
Practice Address - Fax:770-988-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHR006755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHR006755OtherDC LICENSE