Provider Demographics
NPI:1063681476
Name:BALANCED BODY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:BALANCED BODY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-723-5715
Mailing Address - Street 1:223 MEADOW STREET SUITE 3
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4180
Mailing Address - Country:US
Mailing Address - Phone:203-723-5715
Mailing Address - Fax:203-725-0540
Practice Address - Street 1:223 MEADOW STREET SUITE 3
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4180
Practice Address - Country:US
Practice Address - Phone:203-723-5715
Practice Address - Fax:203-725-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTV02476Medicare UPIN