Provider Demographics
NPI:1023027828
Name:BALANCE WELLNESS AND CHIROPRACTIC CENTER P.C.
Entity Type:Organization
Organization Name:BALANCE WELLNESS AND CHIROPRACTIC CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:GAMM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-265-0115
Mailing Address - Street 1:415 W ROCKRIMMON BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1773
Mailing Address - Country:US
Mailing Address - Phone:719-265-0115
Mailing Address - Fax:719-265-0116
Practice Address - Street 1:415 W ROCKRIMMON BLVD STE 400
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1773
Practice Address - Country:US
Practice Address - Phone:719-265-0115
Practice Address - Fax:719-265-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO168923OtherBC/BS PROV. ID
000032212Medicare PIN
MO168923OtherBC/BS PROV. ID