Provider Demographics
NPI:1689803371
Name:BODYALIGN CHIROPRACTIC & MASSAGE THERAPY, INC
Entity Type:Organization
Organization Name:BODYALIGN CHIROPRACTIC & MASSAGE THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-610-4335
Mailing Address - Street 1:10521 HEARTH RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-3714
Mailing Address - Country:US
Mailing Address - Phone:352-610-4335
Mailing Address - Fax:352-610-4336
Practice Address - Street 1:10521 HEARTH RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-3714
Practice Address - Country:US
Practice Address - Phone:352-610-4335
Practice Address - Fax:352-610-4336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 6531111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22832OtherBC/BS OF FLORIDA
FLU39490OtherUPIN
FL350030515OtherRAILROAD MEDICARE
FL350030515OtherRAILROAD MEDICARE