Provider Demographics
NPI:1679952634
Name:BODY LOGIC CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:BODY LOGIC CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFFAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-510-7007
Mailing Address - Street 1:145 CORDANA CT
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-1313
Mailing Address - Country:US
Mailing Address - Phone:716-510-7007
Mailing Address - Fax:
Practice Address - Street 1:1880 N TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:N FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-3366
Practice Address - Country:US
Practice Address - Phone:716-510-7007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-23
Last Update Date:2015-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty