Provider Demographics
NPI:1972057800
Name:BODY OF LIGHT WELLNESS CENTER
Entity type:Organization
Organization Name:BODY OF LIGHT WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FRITZ
Authorized Official - Middle Name:J
Authorized Official - Last Name:PHILIPPE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:754-816-5976
Mailing Address - Street 1:2500 HOLLYWOOD BLVD
Mailing Address - Street 2:206
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6615
Mailing Address - Country:US
Mailing Address - Phone:754-816-5976
Mailing Address - Fax:
Practice Address - Street 1:2500 HOLLYWOOD BLVD
Practice Address - Street 2:206
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6615
Practice Address - Country:US
Practice Address - Phone:754-816-5976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty