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General NPI Number Information
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NPI Number | 1699809756
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Entity Type | Organization
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Legal Business Name | BODYWISE CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 19332 HIGHWAY 169
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City | ELK RIVER
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State | MN
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Zip | 55330-4645
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Country | US
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Telephone | 763-441-7788
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Fax | 763-441-8818
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Provider Business Mailing Address
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Address Line | 19332 HIGHWAY 169
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City | ELK RIVER
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State | MN
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Zip | 55330-4645
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Country | US
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Telephone | 763-441-7788
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Fax | 763-441-8818
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Authorized Official
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Title or Position | MEMBER
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Name | DR. DANIEL GERALD MOORE
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Credential | D.C.
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Telephone | 763-441-7788
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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 | 003531
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License Number State | MN
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