Provider Demographics
NPI:1790968477
Name:BODYWISE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:BODYWISE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-440-4511
Mailing Address - Street 1:4685 S ASH AVE
Mailing Address - Street 2:SUITE H-1
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6857
Mailing Address - Country:US
Mailing Address - Phone:480-775-2593
Mailing Address - Fax:480-621-5485
Practice Address - Street 1:4685 S ASH AVE
Practice Address - Street 2:SUITE H-1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6857
Practice Address - Country:US
Practice Address - Phone:480-775-2593
Practice Address - Fax:480-621-5485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty