Provider Demographics
NPI:1649502105
Name:BOB MATHEWS PERFECT BODY SYSTEM 1 LLC
Entity type:Organization
Organization Name:BOB MATHEWS PERFECT BODY SYSTEM 1 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-279-3900
Mailing Address - Street 1:29 W THOMAS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4400
Mailing Address - Country:US
Mailing Address - Phone:602-279-3900
Mailing Address - Fax:
Practice Address - Street 1:29 W THOMAS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4400
Practice Address - Country:US
Practice Address - Phone:602-279-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty