Provider Demographics
NPI:1003988171
Name:BODY BALANCE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BODY BALANCE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:WARNER
Authorized Official - Last Name:SWEDBERG
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:505-275-6705
Mailing Address - Street 1:3705 WESTERFELD DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3462
Mailing Address - Country:US
Mailing Address - Phone:505-275-6705
Mailing Address - Fax:
Practice Address - Street 1:3705 WESTERFELD DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3462
Practice Address - Country:US
Practice Address - Phone:505-275-6705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1515111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1134104235OtherNPI
NMU85648Medicare ID - Type Unspecified