Provider Demographics
NPI:1013460815
Name:MIND, BODY & SOUL CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:MIND, BODY & SOUL CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-972-9038
Mailing Address - Street 1:1224 MACKINAW AVE
Mailing Address - Street 2:APT. 1C
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5724
Mailing Address - Country:US
Mailing Address - Phone:773-972-9038
Mailing Address - Fax:
Practice Address - Street 1:1224 MACKINAW AVE
Practice Address - Street 2:APT. 1C
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5724
Practice Address - Country:US
Practice Address - Phone:773-972-9038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIND, BODY & SOUL CHIROPRACTIC CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty