Provider Demographics
NPI:1932368719
Name:BODY GENESIS HOLISITC HEALTH AND WELLNESS CENTER
Entity Type:Organization
Organization Name:BODY GENESIS HOLISITC HEALTH AND WELLNESS CENTER
Other - Org Name:BODY GENESIS CENTER FOR INTEGRATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIBURD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-343-3368
Mailing Address - Street 1:937 S MANNHEIM RD
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-2552
Mailing Address - Country:US
Mailing Address - Phone:708-343-3368
Mailing Address - Fax:708-343-4079
Practice Address - Street 1:937 S MANNHEIM RD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-2552
Practice Address - Country:US
Practice Address - Phone:708-343-3368
Practice Address - Fax:708-343-4079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010603111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty