Healthcare Provider Details

I. General information

NPI: 1114799046
Provider Name (Legal Business Name): BODYWISE HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4653 S LAKESHORE DR STE 1
TEMPE AZ
85282-7161
US

IV. Provider business mailing address

4653 S LAKESHORE DR STE 1
TEMPE AZ
85282-7161
US

V. Phone/Fax

Practice location:
  • Phone: 480-335-4737
  • Fax:
Mailing address:
  • Phone: 480-335-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. BARBARA BENNETT
Title or Position: OWNER
Credential: DC
Phone: 480-335-4737