Provider Demographics
NPI:1326362401
Name:BODY SHOP DAY SPA, INC.
Entity type:Organization
Organization Name:BODY SHOP DAY SPA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LEAD ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HUREWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-897-3566
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-0183
Mailing Address - Country:US
Mailing Address - Phone:310-897-3566
Mailing Address - Fax:310-534-3636
Practice Address - Street 1:615 W 9TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3107
Practice Address - Country:US
Practice Address - Phone:310-897-3566
Practice Address - Fax:310-534-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty