Provider Demographics
NPI:1861885238
Name:BODYVOLVE
Entity type:Organization
Organization Name:BODYVOLVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-999-9468
Mailing Address - Street 1:2716 SAN PEDRO DR NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3331
Mailing Address - Country:US
Mailing Address - Phone:505-999-9468
Mailing Address - Fax:
Practice Address - Street 1:2716 SAN PEDRO DR NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3331
Practice Address - Country:US
Practice Address - Phone:505-999-9468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty