Provider Demographics
NPI:1376888123
Name:FIX BODY GROUP
Entity Type:Organization
Organization Name:FIX BODY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:ROBEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-295-9791
Mailing Address - Street 1:1010 UNIVERSITY AVE. C.-201
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-295-9791
Mailing Address - Fax:619-295-9792
Practice Address - Street 1:1010 UNIVERSITY AVE. C-201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-295-9791
Practice Address - Fax:619-295-9792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty