Provider Demographics
NPI:1679327183
Name:BRAIN AND BODY CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:BRAIN AND BODY CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNOR
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-702-0553
Mailing Address - Street 1:6771 PROFESSIONAL PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8460
Mailing Address - Country:US
Mailing Address - Phone:941-702-0553
Mailing Address - Fax:
Practice Address - Street 1:6771 PROFESSIONAL PKWY STE 102
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8460
Practice Address - Country:US
Practice Address - Phone:941-702-0553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty