Provider Demographics
NPI:1508008137
Name:BODYLOGIC MD OF COLUMBUS, LLC
Entity Type:Organization
Organization Name:BODYLOGIC MD OF COLUMBUS, LLC
Other - Org Name:BODYLOGIC MD OF COLUMBUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:888-657-4562
Mailing Address - Street 1:1120 POLARIS PKWY
Mailing Address - Street 2:SUITE 100 B
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-4042
Mailing Address - Country:US
Mailing Address - Phone:888-657-4562
Mailing Address - Fax:888-657-4930
Practice Address - Street 1:1120 POLARIS PKWY
Practice Address - Street 2:SUITE 100 B
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-4042
Practice Address - Country:US
Practice Address - Phone:888-657-4562
Practice Address - Fax:888-657-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.005111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty