Provider Demographics
NPI:1215098140
Name:BOB MATHEWS PERFECT BODY SYSTEM LLC
Entity type:Organization
Organization Name:BOB MATHEWS PERFECT BODY SYSTEM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-266-2499
Mailing Address - Street 1:3110 N CENTRAL AVE
Mailing Address - Street 2:#106
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2695
Mailing Address - Country:US
Mailing Address - Phone:602-266-2499
Mailing Address - Fax:602-266-9431
Practice Address - Street 1:3110 N CENTRAL AVE
Practice Address - Street 2:#106
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2695
Practice Address - Country:US
Practice Address - Phone:602-266-2499
Practice Address - Fax:602-266-9431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3679111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty