Provider Demographics
NPI:1124465943
Name:ORGANIC LIFE BODY WORKS, LLC
Entity type:Organization
Organization Name:ORGANIC LIFE BODY WORKS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHTFOOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-490-0603
Mailing Address - Street 1:8600 FOUNDRY ST
Mailing Address - Street 2:PO BOX 2014
Mailing Address - City:SAVAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20763-9512
Mailing Address - Country:US
Mailing Address - Phone:301-490-0603
Mailing Address - Fax:301-490-0603
Practice Address - Street 1:8600 FOUNDRY ST
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MD
Practice Address - Zip Code:20763-9512
Practice Address - Country:US
Practice Address - Phone:301-490-0603
Practice Address - Fax:301-490-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty