Provider Demographics
NPI:1598214777
Name:BODY& SOULWORKS LLC
Entity Type:Organization
Organization Name:BODY& SOULWORKS LLC
Other - Org Name:SETH FRIEDMAN DC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-982-1135
Mailing Address - Street 1:406 LINDA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1630
Mailing Address - Country:US
Mailing Address - Phone:505-982-1135
Mailing Address - Fax:
Practice Address - Street 1:406 LINDA VISTA RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1630
Practice Address - Country:US
Practice Address - Phone:505-982-1135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM093406554Medicare UPIN