Provider Demographics
NPI:1124059902
Name:DESIGNER BODY INC.
Entity type:Organization
Organization Name:DESIGNER BODY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-391-2221
Mailing Address - Street 1:4331 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5127
Mailing Address - Country:US
Mailing Address - Phone:561-391-2221
Mailing Address - Fax:561-750-8017
Practice Address - Street 1:4331 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5127
Practice Address - Country:US
Practice Address - Phone:561-391-2221
Practice Address - Fax:561-750-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88983OtherBLUE CROSS BLUE SHIELD
FL88983OtherBLUE CROSS BLUE SHIELD
FLT56045Medicare UPIN