Provider Demographics
NPI:1871808063
Name:CENTER FOR ADVANCED BODYWORK
Entity type:Organization
Organization Name:CENTER FOR ADVANCED BODYWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRILL
Authorized Official - Suffix:
Authorized Official - Credentials:NCMMT
Authorized Official - Phone:970-663-6501
Mailing Address - Street 1:1931 BOISE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4295
Mailing Address - Country:US
Mailing Address - Phone:970-663-6501
Mailing Address - Fax:
Practice Address - Street 1:1931 BOISE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4295
Practice Address - Country:US
Practice Address - Phone:970-663-6501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation