Provider Demographics
NPI:1295975654
Name:BODY & SPINE CHIROPRACTIC WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:BODY & SPINE CHIROPRACTIC WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:ROOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-558-1711
Mailing Address - Street 1:3902 MAPLE GROVE DR APT 9
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1768
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6200 NESBITT RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-1819
Practice Address - Country:US
Practice Address - Phone:608-558-1711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4369-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty