Provider Demographics
NPI:1033624341
Name:BALANCE CHIROPRACTIC HEALTH CENTER, PLLC
Entity Type:Organization
Organization Name:BALANCE CHIROPRACTIC HEALTH CENTER, PLLC
Other - Org Name:BALANCE NATURAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-789-0547
Mailing Address - Street 1:1 WATER ST W STE 270
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-2053
Mailing Address - Country:US
Mailing Address - Phone:651-789-0547
Mailing Address - Fax:
Practice Address - Street 1:1 WATER ST W STE 270
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-2053
Practice Address - Country:US
Practice Address - Phone:651-789-0547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6368261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center