Provider Demographics
NPI:1598232514
Name:EMBODY INSTITUTE OF FUNCTIONAL HEALTH
Entity Type:Organization
Organization Name:EMBODY INSTITUTE OF FUNCTIONAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:HALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELCHOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-229-9544
Mailing Address - Street 1:PO BOX 440442
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30160-9508
Mailing Address - Country:US
Mailing Address - Phone:228-229-9544
Mailing Address - Fax:
Practice Address - Street 1:10150 WEHIE CAMP RD
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-9701
Practice Address - Country:US
Practice Address - Phone:228-229-9544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health