Provider Demographics
NPI:1235644915
Name:BODY SHOP CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BODY SHOP CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-559-5226
Mailing Address - Street 1:2012 PROVIDENCE PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-6384
Mailing Address - Country:US
Mailing Address - Phone:615-599-5226
Mailing Address - Fax:
Practice Address - Street 1:2012 PROVIDENCE PKWY STE A
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-6384
Practice Address - Country:US
Practice Address - Phone:615-599-5226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty