Provider Demographics
NPI:1508181728
Name:TOTAL BODY HEALTH CENTER SC
Entity Type:Organization
Organization Name:TOTAL BODY HEALTH CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:GANAPATHY
Authorized Official - Last Name:MANI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-587-5824
Mailing Address - Street 1:1121 E MAIN ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2205
Mailing Address - Country:US
Mailing Address - Phone:630-587-5824
Mailing Address - Fax:630-587-5834
Practice Address - Street 1:1121 E MAIN ST
Practice Address - Street 2:SUITE 140
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2205
Practice Address - Country:US
Practice Address - Phone:630-587-5824
Practice Address - Fax:630-587-5834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207829001Medicare PIN