Provider Demographics
NPI:1881945897
Name:BODY LOGIC CHIROPRACTIC CENTER, PLLC
Entity type:Organization
Organization Name:BODY LOGIC CHIROPRACTIC CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-789-3599
Mailing Address - Street 1:6320 ANGUS DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-4756
Mailing Address - Country:US
Mailing Address - Phone:919-789-3599
Mailing Address - Fax:
Practice Address - Street 1:6320 ANGUS DR
Practice Address - Street 2:SUITE D
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-4756
Practice Address - Country:US
Practice Address - Phone:919-789-3599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916100Medicaid
NC5916100Medicaid