Healthcare Provider Details

I. General information

NPI: 1922675172
Provider Name (Legal Business Name): PRIMARY BODY WORKS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MACGREGOR PINES DR STE 101B
CARY NC
27511-6037
US

IV. Provider business mailing address

160 MACGREGOR PINES DR STE 101B
CARY NC
27511-6037
US

V. Phone/Fax

Practice location:
  • Phone: 919-342-8585
  • Fax: 877-808-6177
Mailing address:
  • Phone: 919-342-8585
  • Fax: 877-808-6177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JON MICHAEL BRUCE
Title or Position: CEO
Credential: MD
Phone: 919-342-8585