Healthcare Provider Details

I. General information

NPI: 1033700232
Provider Name (Legal Business Name): BODY BY DOC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2021
Last Update Date: 01/30/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12223 E CLOUD RD
CHANDLER AZ
85249-3424
US

IV. Provider business mailing address

PO BOX 21824
MESA AZ
85277-1824
US

V. Phone/Fax

Practice location:
  • Phone: 480-329-6770
  • Fax:
Mailing address:
  • Phone: 480-329-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. GREGORY CLOPTON
Title or Position: OWNER
Credential:
Phone: 480-329-6770