MEDICARE: FOOD PHYSICS & BODY DYNAMICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator
2	246Y00000X	Health Information Specialist/Technologist
3	2083P0901X	Public Health & General Preventive Medicine Physician
4	208VP0014X	Interventional Pain Medicine Physician
5	133NN1002X	Nutrition Education Nutritionist	U02298	MD
6	261QR1100X	Research Clinic/Center	U02298	MD
7	171100000X	Acupuncturist	U02298	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	016303	OTHER	NATL CERTIFICATION NCCAOM
2	1225108400	OTHER	NPI-OWNER ASSIGNED L DAWSON
3	29-1291	OTHER	STANDARD OF OCCUPATION CODE-ACUPUNCTURIST

General Provider Information

NPI Number	:	1013971381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOD PHYSICS & BODY DYNAMICS LLC

Provider Business Mailing Address
First Line	:	PO BOX 56
Second Line	:
City	:	CASTLE HAYNE
State	:	NC
Zip	:	28429-0056
Country	:	US
Telephone Number	:	910-777-7307
Fax Number	:

Provider Business Practice Location Address
First Line	:	2826 BELLWOOD AVE
Second Line	:
City	:	CASTLE HAYNE
State	:	NC
Zip	:	28429-6506
Country	:	US
Telephone Number	:	910-777-7307
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. LAURA L DAWSON
Credential	:	MAOM, DIPL.AC., L.AC
Telephone Number	:	910-777-7307

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	09/18/2016

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