Provider Demographics
NPI:1427578848
Name:BODY SYSTEMS WELLNESS GROUP INC
Entity type:Organization
Organization Name:BODY SYSTEMS WELLNESS GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KURESTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-240-2233
Mailing Address - Street 1:800 S CENTRAL AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4379
Mailing Address - Country:US
Mailing Address - Phone:818-240-2233
Mailing Address - Fax:818-240-2237
Practice Address - Street 1:800 S CENTRAL AVE STE 206
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4379
Practice Address - Country:US
Practice Address - Phone:818-240-2233
Practice Address - Fax:818-240-2237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31558111N00000X
CADC27167111N00000X
CADC33522111N00000X
CAC35643208200000X
CAA122407208VP0014X
CA95007091363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA122407OtherPAIN MEDICINE INTERVENTIONAL
CADC33522OtherCHIROPRACTOR
CAC35643OtherPLASTIC SURGERY
CADC27167OtherCHIROPRACTOR
CADC31558OtherCHIROPRACTOR
CA9500791OtherNURSE PRACTIONER
CAA122407OtherPAINE MEDICINE INTERVENTIONAL