Provider Demographics
NPI:1689716177
Name:BODYWORKS CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:BODYWORKS CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THERON
Authorized Official - Middle Name:B
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-302-0301
Mailing Address - Street 1:1218 WEST SOUTH JORDAN PARKWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095
Mailing Address - Country:US
Mailing Address - Phone:801-302-0301
Mailing Address - Fax:801-302-0311
Practice Address - Street 1:1218 WEST SOUTH JORDAN PARKWAY
Practice Address - Street 2:SUITE A
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095
Practice Address - Country:US
Practice Address - Phone:801-302-0301
Practice Address - Fax:801-302-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3552091202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
76597Medicare UPIN