Provider Demographics
NPI:1285363937
Name:WHOLE BODY HEALTH LLC
Entity type:Organization
Organization Name:WHOLE BODY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GUSTITUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-839-0983
Mailing Address - Street 1:5213 27TH RD N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1724
Mailing Address - Country:US
Mailing Address - Phone:414-839-0983
Mailing Address - Fax:
Practice Address - Street 1:8391 OLD COURTHOUSE RD STE 350
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3819
Practice Address - Country:US
Practice Address - Phone:414-839-0983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3937-012OtherSTATE LICENSE