Provider Demographics
NPI:1851647895
Name:TOTAL BODY CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:TOTAL BODY CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BULLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-227-2639
Mailing Address - Street 1:415 E KIRACOFE AVE
Mailing Address - Street 2:
Mailing Address - City:ELIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-1031
Mailing Address - Country:US
Mailing Address - Phone:419-227-2639
Mailing Address - Fax:419-227-2640
Practice Address - Street 1:415 E KIRACOFE AVE
Practice Address - Street 2:
Practice Address - City:ELIDA
Practice Address - State:OH
Practice Address - Zip Code:45807-1031
Practice Address - Country:US
Practice Address - Phone:419-227-2639
Practice Address - Fax:419-227-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty