Healthcare Provider Details

I. General information

NPI: 1619145331
Provider Name (Legal Business Name): BODY DYNAMIX CHIROPRACTIC AND PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17609 VENTURA BLVD STE. LL07
ENCINO CA
91316-5134
US

IV. Provider business mailing address

17609 VENTURA BLVD STE. LL07
ENCINO CA
91316-5134
US

V. Phone/Fax

Practice location:
  • Phone: 818-783-4085
  • Fax: 818-783-4065
Mailing address:
  • Phone: 818-783-4085
  • Fax: 818-783-4065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD BEAU DANIELS
Title or Position: PARTNER
Credential: D.C., C.S.C.S.
Phone: 818-783-4085