Provider Demographics
NPI:1821430273
Name:A BODY IN MOTION LLC
Entity Type:Organization
Organization Name:A BODY IN MOTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-444-6293
Mailing Address - Street 1:100 ROYAL PALM WAY APT 102
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-8752
Mailing Address - Country:US
Mailing Address - Phone:954-444-6293
Mailing Address - Fax:954-616-5851
Practice Address - Street 1:1395 W SUNRISE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-7075
Practice Address - Country:US
Practice Address - Phone:954-444-6293
Practice Address - Fax:954-616-5851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty