Healthcare Provider Details

I. General information

NPI: 1972477867
Provider Name (Legal Business Name): BEYOND THE BODY WELLNESS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2354 RIDGECREST DR
ARNOLD MO
63010-2237
US

IV. Provider business mailing address

2354 RIDGECREST DR
ARNOLD MO
63010-2237
US

V. Phone/Fax

Practice location:
  • Phone: 111-111-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: THEODORE VALLEY
Title or Position: OWNER
Credential: DC
Phone: 111-111-1111