Provider Demographics
NPI:1881006401
Name:BODY INTELLIGENCE HOLISTIC HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:BODY INTELLIGENCE HOLISTIC HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOALT
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:203-710-3937
Mailing Address - Street 1:90 SANDS PL
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-6661
Mailing Address - Country:US
Mailing Address - Phone:203-710-3937
Mailing Address - Fax:
Practice Address - Street 1:90 SANDS PL
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-6661
Practice Address - Country:US
Practice Address - Phone:203-710-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty