Provider Demographics
NPI:1477615870
Name:BODYWORKS CHIROPRACTIC & WELLNESS CENTER INC.
Entity Type:Organization
Organization Name:BODYWORKS CHIROPRACTIC & WELLNESS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:STOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-802-1640
Mailing Address - Street 1:2705 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-4400
Mailing Address - Country:US
Mailing Address - Phone:480-802-1640
Mailing Address - Fax:
Practice Address - Street 1:2705 S ALMA SCHOOL ROAD #2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286
Practice Address - Country:US
Practice Address - Phone:480-802-1640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U80280Medicare UPIN
AZZ80748Medicare PIN