Provider Demographics
NPI:1003078700
Name:BALANCED LIVING CHIROPRACTIC OF ROCHESTER PLLC
Entity Type:Organization
Organization Name:BALANCED LIVING CHIROPRACTIC OF ROCHESTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/D.C.
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CICALA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-652-7225
Mailing Address - Street 1:1000 W UNIVERSITY DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1873
Mailing Address - Country:US
Mailing Address - Phone:248-652-7225
Mailing Address - Fax:248-652-7292
Practice Address - Street 1:1000 W UNIVERSITY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1873
Practice Address - Country:US
Practice Address - Phone:248-652-7225
Practice Address - Fax:248-652-7292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95-0-F3-5689-0OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI95-0-F3-5689-0OtherBLUE CROSS BLUE SHIELD OF MICHIGAN