Provider Demographics
NPI:1780262303
Name:POINT WELLNESS BODY SHOP
Entity type:Organization
Organization Name:POINT WELLNESS BODY SHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-244-2822
Mailing Address - Street 1:5000 ESTATE ENIGHED STE 313
Mailing Address - Street 2:
Mailing Address - City:ST JOHN
Mailing Address - State:VI
Mailing Address - Zip Code:00830-6120
Mailing Address - Country:US
Mailing Address - Phone:340-244-2822
Mailing Address - Fax:886-864-5578
Practice Address - Street 1:5 ENIGHED
Practice Address - Street 2:BUILDING #2
Practice Address - City:ST JOHN
Practice Address - State:VI
Practice Address - Zip Code:00830
Practice Address - Country:US
Practice Address - Phone:340-244-2822
Practice Address - Fax:886-864-5578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI86OtherCHIROPRACTIC LICENSE