Healthcare Provider Details

I. General information

NPI: 1972370732
Provider Name (Legal Business Name): BODY MEDICAL WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17609 VENTURA BLVD STE 104
ENCINO CA
91316-5148
US

IV. Provider business mailing address

17609 VENTURA BLVD STE 104
ENCINO CA
91316-5148
US

V. Phone/Fax

Practice location:
  • Phone: 818-291-3636
  • Fax: 877-395-9650
Mailing address:
  • Phone: 818-291-3636
  • Fax: 877-395-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: RUBEN G CHLDRYAN
Title or Position: PRESIDENT
Credential: DC
Phone: 818-291-3636