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General NPI Number Information
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NPI Number | 1710619598
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Entity Type | Organization
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Legal Business Name | EMBODY WELLNESS CHIROPRACTIC CENTER PLLC
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 80 ACOMA BLVD S STE 104
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-6926
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Country | US
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Telephone | 928-453-1055
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Fax | 928-453-1057
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Provider Business Mailing Address
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Address Line | 80 ACOMA BLVD S STE 104
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-6926
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Country | US
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Telephone | 928-453-1055
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Fax | 928-453-1057
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Authorized Official
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Title or Position | OWNER
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Name | SHELLEY BENGARD
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Credential | DC
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Telephone | 714-396-2284
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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 |
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License Number State |
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