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General NPI Number Information
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NPI Number | 1235378076
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Entity Type | Organization
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Legal Business Name | HEALTHY BODY CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 2400 HIGHWAY 287 N SUITE 104
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City | MANSFIELD
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State | TX
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Zip | 76063-4828
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Country | US
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Telephone | 817-539-0044
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Fax | 866-317-9352
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Provider Business Mailing Address
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Address Line | 2400 HIGHWAY 287 N SUITE 104
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City | MANSFIELD
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State | TX
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Zip | 76063-4828
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Country | US
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Telephone | 817-539-0044
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Fax | 866-317-9352
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARCELLE PETRY
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Credential | D.C.
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Telephone | 817-539-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 9680
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License Number State | TX
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