Provider Demographics
NPI:1992947931
Name:BODY FIRST CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BODY FIRST CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-942-2304
Mailing Address - Street 1:1913 E PLEASANT VALLEY BLVD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-7509
Mailing Address - Country:US
Mailing Address - Phone:814-942-2304
Mailing Address - Fax:814-942-8004
Practice Address - Street 1:1913 E PLEASANT VALLEY BLVD
Practice Address - Street 2:SUITE #2
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-7509
Practice Address - Country:US
Practice Address - Phone:814-942-2304
Practice Address - Fax:814-942-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA152361Medicare UPIN
PA152361Medicare PIN