Provider Demographics
NPI:1710297635
Name:CHIRO-INJURY AND WELLNESS, LLC
Entity Type:Organization
Organization Name:CHIRO-INJURY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BODANZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-931-7474
Mailing Address - Street 1:205 W BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7900
Mailing Address - Country:US
Mailing Address - Phone:813-931-7474
Mailing Address - Fax:813-931-7102
Practice Address - Street 1:205 W BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7900
Practice Address - Country:US
Practice Address - Phone:813-931-7474
Practice Address - Fax:813-931-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty