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General NPI Number Information
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NPI Number | 1699100586
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Entity Type | Organization
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Legal Business Name | BODYWORX HEALTH STUDIO LLC
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 13291 W MCDOWELL RD STE E4
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City | GOODYEAR
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State | AZ
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Zip | 85395-2634
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Country | US
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Telephone | 623-218-6676
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Fax |
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Provider Business Mailing Address
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Address Line | 13291 W MCDOWELL RD STE E4
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City | GOODYEAR
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State | AZ
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Zip | 85395-2634
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Country | US
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Telephone | 623-218-6676
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JACOB HAMBLIN HEALEY
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Credential | D.C.
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Telephone | 602-710-6050
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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 | 8203
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License Number State | AZ
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