MEDICARE: BODY IN BALANCE HEALTH CENTER AND SPA

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	111N00000X	Chiropractor	DC28002	CA

General Provider Information

NPI Number	:	1740404532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY IN BALANCE HEALTH CENTER AND SPA

Provider Business Mailing Address
First Line	:	808 MANHATTAN AVE
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5532
Country	:	US
Telephone Number	:	310-406-1910
Fax Number	:

Provider Business Practice Location Address
First Line	:	808 MANHATTAN AVE
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5532
Country	:	US
Telephone Number	:	310-406-1910
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NAZILA MAHGEREFTEH
Credential	:	DC
Telephone Number	:	310-406-1910

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	08/22/2020

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