Healthcare Provider Details

I. General information

NPI: 1427578848
Provider Name (Legal Business Name): BODY SYSTEMS WELLNESS GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 07/21/2022
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S CENTRAL AVE STE 206
GLENDALE CA
91204-4379
US

IV. Provider business mailing address

800 S CENTRAL AVE STE 206
GLENDALE CA
91204-4379
US

V. Phone/Fax

Practice location:
  • Phone: 818-240-2233
  • Fax: 818-240-2237
Mailing address:
  • Phone: 818-240-2233
  • Fax: 818-240-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC31558
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27167
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC33522
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberC35643
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA122407
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95007091
License Number StateCA

VIII. Authorized Official

Name: SHAHEN KURESTIAN
Title or Position: PROVIDER
Credential: D.C.
Phone: 818-240-2233