Provider Demographics
NPI:1720220338
Name:AGELESS HEALTH INSTITUTE, PC
Entity Type:Organization
Organization Name:AGELESS HEALTH INSTITUTE, PC
Other - Org Name:BODYLOGICMD OF PHOENIX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:HONING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-461-4647
Mailing Address - Street 1:18275 N 59TH AVE
Mailing Address - Street 2:SUITE 162 BUILDING K
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1260
Mailing Address - Country:US
Mailing Address - Phone:888-461-4647
Mailing Address - Fax:602-680-7857
Practice Address - Street 1:20616 N CAVE CREEK RD
Practice Address - Street 2:SUITE B110
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-4451
Practice Address - Country:US
Practice Address - Phone:888-461-4647
Practice Address - Fax:602-680-7857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29176174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty