Provider Demographics
NPI:1073989729
Name:BALANCED HEALTH CHIROPRACTIC & WELLNESS, PC
Entity Type:Organization
Organization Name:BALANCED HEALTH CHIROPRACTIC & WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:NEIBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-751-3454
Mailing Address - Street 1:3831 LOCKPORT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-5539
Mailing Address - Country:US
Mailing Address - Phone:701-751-3454
Mailing Address - Fax:
Practice Address - Street 1:3831 LOCKPORT ST
Practice Address - Street 2:SUITE B
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-5539
Practice Address - Country:US
Practice Address - Phone:701-751-3454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN722013Medicare PIN