Provider Demographics
NPI:1427289701
Name:BODHI BODY INTEGRATIVE MEDICAL CENTERS
Entity type:Organization
Organization Name:BODHI BODY INTEGRATIVE MEDICAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO,MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ONEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-636-0152
Mailing Address - Street 1:6543 E HEARN RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3327
Mailing Address - Country:US
Mailing Address - Phone:480-636-0152
Mailing Address - Fax:
Practice Address - Street 1:2915 W RAY RD
Practice Address - Street 2:SUITE 8
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3631
Practice Address - Country:US
Practice Address - Phone:480-636-0143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BODHI CENTER DEVELOPMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care