Provider Demographics
NPI:1891445045
Name:BODY IN MOTION CHIROPRACTIC
Entity Type:Organization
Organization Name:BODY IN MOTION CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:SHOTWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:936-564-4000
Mailing Address - Street 1:3500 NORTH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2466
Mailing Address - Country:US
Mailing Address - Phone:936-564-4000
Mailing Address - Fax:936-564-4002
Practice Address - Street 1:3500 NORTH ST STE 2
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2466
Practice Address - Country:US
Practice Address - Phone:936-564-4000
Practice Address - Fax:936-564-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty