Provider Demographics
NPI:1811267925
Name:BODY CHIROPRACTIC
Entity type:Organization
Organization Name:BODY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:FLETCHER
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-501-3851
Mailing Address - Street 1:7671 NORTHWOODS BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4058
Mailing Address - Country:US
Mailing Address - Phone:843-820-5313
Mailing Address - Fax:843-225-9024
Practice Address - Street 1:7671 NORTHWOODS BLVD STE G
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4058
Practice Address - Country:US
Practice Address - Phone:843-820-5313
Practice Address - Fax:843-225-9024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007286111N00000X
SC3625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty