Provider Demographics
NPI:1740404532
Name:BODY IN BALANCE HEALTH CENTER AND SPA
Entity Type:Organization
Organization Name:BODY IN BALANCE HEALTH CENTER AND SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZILA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHGEREFTEH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-406-1910
Mailing Address - Street 1:808 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5532
Mailing Address - Country:US
Mailing Address - Phone:310-406-1910
Mailing Address - Fax:
Practice Address - Street 1:808 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5532
Practice Address - Country:US
Practice Address - Phone:310-406-1910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty