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General NPI Number Information
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NPI Number | 1821430273
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Entity Type | Organization
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Legal Business Name | A BODY IN MOTION LLC
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Dates
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Enumeration Date | 07/26/2013
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Last Update Date | 07/26/2013
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Provider Practice Location Address
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Address Line | 1395 W SUNRISE BLVD STE 1
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City | FT LAUDERDALE
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State | FL
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Zip | 33311-7075
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Country | US
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Telephone | 954-444-6293
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Fax | 954-616-5851
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Provider Business Mailing Address
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Address Line | 100 ROYAL PALM WAY APT 102
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City | BOCA RATON
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State | FL
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Zip | 33432-8752
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Country | US
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Telephone | 954-444-6293
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Fax | 954-616-5851
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON M GILL
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Credential | D.C.
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Telephone | 954-444-6293
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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 | CH10594
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License Number State | FL
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