Provider Demographics
NPI:1588022339
Name:EMPTYHANDBODYWORK
Entity Type:Organization
Organization Name:EMPTYHANDBODYWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WELLNESS PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KAYODE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GIWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-384-4121
Mailing Address - Street 1:3522 INDIANA AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2854
Mailing Address - Country:US
Mailing Address - Phone:612-384-4121
Mailing Address - Fax:
Practice Address - Street 1:3522 INDIANA AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2854
Practice Address - Country:US
Practice Address - Phone:612-384-4121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN264555172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty