Provider Demographics
NPI:1205303997
Name:LASER THERAPY BODY INC
Entity type:Organization
Organization Name:LASER THERAPY BODY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THEA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:HOFMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-517-1663
Mailing Address - Street 1:817 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-1032
Mailing Address - Country:US
Mailing Address - Phone:615-563-4443
Mailing Address - Fax:615-563-4550
Practice Address - Street 1:817 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1032
Practice Address - Country:US
Practice Address - Phone:615-563-4443
Practice Address - Fax:615-563-4550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty