Provider Demographics
NPI:1083363402
Name:BACK IN BALANCE
Entity Type:Organization
Organization Name:BACK IN BALANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:R
Authorized Official - Last Name:MITCHELL STEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-885-9078
Mailing Address - Street 1:3952 S FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4604
Mailing Address - Country:US
Mailing Address - Phone:417-885-9078
Mailing Address - Fax:417-885-9072
Practice Address - Street 1:591 E ELM ST
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1317
Practice Address - Country:US
Practice Address - Phone:417-987-2444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty