Provider Demographics
NPI:1679844617
Name:BODY IN MOTION CHIROPRACTIC
Entity type:Organization
Organization Name:BODY IN MOTION CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/TREATING DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OVTCHAROV
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-279-6466
Mailing Address - Street 1:609 PRICE AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1420
Mailing Address - Country:US
Mailing Address - Phone:650-279-6466
Mailing Address - Fax:650-599-9205
Practice Address - Street 1:609 PRICE AVE STE 106
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1420
Practice Address - Country:US
Practice Address - Phone:650-279-6466
Practice Address - Fax:650-599-9205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31971111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty