Provider Demographics
NPI:1760978399
Name:BODY & HEALING EVOLUTION, LLC
Entity Type:Organization
Organization Name:BODY & HEALING EVOLUTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:JR
Authorized Official - Credentials:LAC
Authorized Official - Phone:305-942-5430
Mailing Address - Street 1:7100 BISCAYNE BLVD STE 311
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-5769
Mailing Address - Country:US
Mailing Address - Phone:305-942-5430
Mailing Address - Fax:305-631-2400
Practice Address - Street 1:7100 BISCAYNE BLVD STE 311
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-5769
Practice Address - Country:US
Practice Address - Phone:305-942-5430
Practice Address - Fax:305-631-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty