Healthcare Provider Details

I. General information

NPI: 1780262303
Provider Name (Legal Business Name): POINT WELLNESS BODY SHOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 04/02/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ENIGHED BUILDING #2
ST JOHN VI
00830
US

IV. Provider business mailing address

5000 ESTATE ENIGHED STE 313
ST JOHN VI
00830-6120
US

V. Phone/Fax

Practice location:
  • Phone: 340-244-2822
  • Fax: 886-864-5578
Mailing address:
  • Phone: 340-244-2822
  • Fax: 886-864-5578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY GOODWINE
Title or Position: OWNER
Credential:
Phone: 340-244-2822