Provider Demographics
NPI:1598336919
Name:BODY, MIND & SPINE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BODY, MIND & SPINE CHIROPRACTIC LLC
Other - Org Name:BODY MIND & SPINE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:CHASE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-313-0086
Mailing Address - Street 1:9325 TARVER DR STE C-102
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-6162
Mailing Address - Country:US
Mailing Address - Phone:254-313-0086
Mailing Address - Fax:
Practice Address - Street 1:9325 TARVER DR STE C-102
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-6162
Practice Address - Country:US
Practice Address - Phone:806-781-8644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty