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General NPI Number Information
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NPI Number | 1356773154
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Entity Type | Organization
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Legal Business Name | RAW BODY WORKS
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Dates
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Enumeration Date | 08/02/2013
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Last Update Date | 08/02/2013
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Provider Practice Location Address
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Address Line | 3185 BABCOCK BLVD
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City | PITTSBURGH
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State | PA
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Zip | 15237-2727
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Country | US
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Telephone | 412-367-2444
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Fax |
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Provider Business Mailing Address
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Address Line | 111 WHITEHEAD LN SUITE 100
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City | MONROEVILLE
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State | PA
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Zip | 15146-2756
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Country | US
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Telephone | 412-357-2640
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | BRYAN THOMAS KLAUS
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Credential | DC
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Telephone | 412-357-2640
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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 | DC007679L
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License Number State | PA
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