Provider Demographics
NPI:1952525826
Name:BODY BEYOND CHIROPRACTIC AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:BODY BEYOND CHIROPRACTIC AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:KIRKWOOD
Authorized Official - Last Name:EDGINTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-931-6578
Mailing Address - Street 1:3258 N RACINE AVE
Mailing Address - Street 2:2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3322
Mailing Address - Country:US
Mailing Address - Phone:773-931-6578
Mailing Address - Fax:708-788-5620
Practice Address - Street 1:3258 N RACINE AVE
Practice Address - Street 2:2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3322
Practice Address - Country:US
Practice Address - Phone:773-931-6578
Practice Address - Fax:708-788-5620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty