Provider Demographics
NPI:1750914891
Name:MY BODYWORX CHIROPRACTIC LLC
Entity type:Organization
Organization Name:MY BODYWORX CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-926-9494
Mailing Address - Street 1:301 W ATLANTIC AVE STE R6
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-3688
Mailing Address - Country:US
Mailing Address - Phone:561-926-9494
Mailing Address - Fax:
Practice Address - Street 1:301 W ATLANTIC AVE STE R6
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-3688
Practice Address - Country:US
Practice Address - Phone:561-926-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty