Provider Demographics
NPI:1356637425
Name:BIODYNAMIC HEALTH SERVICES INCORPORATED
Entity Type:Organization
Organization Name:BIODYNAMIC HEALTH SERVICES INCORPORATED
Other - Org Name:FREEDOM CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-381-8700
Mailing Address - Street 1:360 ARBOR DR STE H
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6688
Mailing Address - Country:US
Mailing Address - Phone:540-381-8700
Mailing Address - Fax:540-381-8700
Practice Address - Street 1:360 ARBOR DR STE H
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6688
Practice Address - Country:US
Practice Address - Phone:540-381-8700
Practice Address - Fax:540-381-8700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002024111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty