Provider Demographics
NPI:1922675172
Name:PRIMARY BODY WORKS, PLLC
Entity Type:Organization
Organization Name:PRIMARY BODY WORKS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-342-8585
Mailing Address - Street 1:160 MACGREGOR PINES DR STE 101B
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6037
Mailing Address - Country:US
Mailing Address - Phone:919-342-8585
Mailing Address - Fax:877-808-6177
Practice Address - Street 1:160 MACGREGOR PINES DR STE 101B
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6037
Practice Address - Country:US
Practice Address - Phone:919-342-8585
Practice Address - Fax:877-808-6177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty