Provider Demographics
NPI:1083056261
Name:LIFE BALANCE CHIROPRACTIC AND REHABILITATION INC.
Entity Type:Organization
Organization Name:LIFE BALANCE CHIROPRACTIC AND REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:GEC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-240-9821
Mailing Address - Street 1:4727 WILLOW SPRINGS RD
Mailing Address - Street 2:SUITE 1S
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6140
Mailing Address - Country:US
Mailing Address - Phone:630-240-9821
Mailing Address - Fax:
Practice Address - Street 1:4727 WILLOW SPRINGS RD
Practice Address - Street 2:SUITE 1S
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6140
Practice Address - Country:US
Practice Address - Phone:630-240-9821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty