Colleyville Body Focus Wellness Clinic, LLC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

N5550 Issued in TX

Legal business name

COLLEYVILLE BODY FOCUS WELLNESS CLINIC, LLC

Practice address

4620 Colleyville Blvd
Ste 102
Colleyville, TX 76034-3971

Phone

(817) 427-3700

NPI assigned

Dec 7, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cheri Davus

Title

Credentialing Manager

Phone

(972) 792-5700

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Juvia Med Spa Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1449446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449446400000",
    "number": "1891160552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9101 LBJ FWY",
            "address_2": "STE 710",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752432057",
            "telephone_number": "972-792-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4620 COLLEYVILLE BLVD",
            "address_2": "STE 102",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760343971",
            "telephone_number": "817-427-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEYVILLE BODY FOCUS WELLNESS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-07",
        "last_updated": "2015-12-07",
        "status": "A",
        "authorized_official_last_name": "DAVUS",
        "authorized_official_first_name": "CHERI",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "972-792-5700"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "TX",
            "license": "N5550",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "TX",
            "license": "N5550",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TMB",
            "identifier": "N5550",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Juvia Med Spa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberly Coffee, AGPCNP
• Colin Tkachuk
• Collaborative Counselor Enterprises, PLLC
• Collaborative Wellness Center LLC
• Colleyville Body Focus Spa and Wellness Dba Juvia Med Spa
• Colleyville Chiropractic, PLLC
• Colleyville Dentistry PLLC
• Colleyville Eye Corporation
• Colleyville Medical Center LLC
• Colleyville Physical Therapy and Sports Rehab, PC

• Anesthesiology Physician in Colleyville, TX
• Providers in Colleyville, TX by specialty
• Anesthesiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.