Provider Demographics
NPI:1891156139
Name:CORE HEALING BODYWORKS
Entity Type:Organization
Organization Name:CORE HEALING BODYWORKS
Other - Org Name:CORE HEALING BODYWORKS MASSAGE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORIAN
Authorized Official - Middle Name:DELON
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:810-282-4278
Mailing Address - Street 1:G3277 BEECHER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3615
Mailing Address - Country:US
Mailing Address - Phone:810-282-4278
Mailing Address - Fax:
Practice Address - Street 1:G3277 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3615
Practice Address - Country:US
Practice Address - Phone:810-282-4278
Practice Address - Fax:810-396-6117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center