Provider Demographics
NPI:1013627512
Name:BODY REVOLUTION HEALTHCARE CONSULTANTS
Entity Type:Organization
Organization Name:BODY REVOLUTION HEALTHCARE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL CONSULTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:DHA
Authorized Official - Phone:770-557-6502
Mailing Address - Street 1:11939 SCOTTISH CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-8052
Mailing Address - Country:US
Mailing Address - Phone:770-557-6502
Mailing Address - Fax:
Practice Address - Street 1:11939 SCOTTISH CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-8052
Practice Address - Country:US
Practice Address - Phone:770-557-6502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty