Healthcare Provider Details

I. General information

NPI: 1275892069
Provider Name (Legal Business Name): BODY SOLUTIONS CHIROPRACTIC CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 COURT AVE
BEDFORD IA
50833-1303
US

IV. Provider business mailing address

618 COURT AVE
BEDFORD IA
50833-1303
US

V. Phone/Fax

Practice location:
  • Phone: 712-523-2768
  • Fax:
Mailing address:
  • Phone: 712-523-2768
  • Fax: 712-523-3469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007528
License Number StateIA

VIII. Authorized Official

Name: DEL RAE DERRY
Title or Position: PRESIDENT
Credential: DC
Phone: 712-370-0656