Provider Demographics
NPI:1568842953
Name:THE HUMAN BODY SHOP
Entity Type:Organization
Organization Name:THE HUMAN BODY SHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:ANDRU
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-369-6920
Mailing Address - Street 1:617 SOLANO DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-3380
Mailing Address - Country:US
Mailing Address - Phone:505-369-6920
Mailing Address - Fax:505-433-6422
Practice Address - Street 1:617 SOLANO DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3380
Practice Address - Country:US
Practice Address - Phone:505-369-6920
Practice Address - Fax:505-433-6422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center