Provider Demographics
NPI:1083801559
Name:ACTIVE BALANCE CHIROPRACTIC & ACUPUNCTURE CLINIC, LLC
Entity Type:Organization
Organization Name:ACTIVE BALANCE CHIROPRACTIC & ACUPUNCTURE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-626-3274
Mailing Address - Street 1:418 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:67730-1826
Mailing Address - Country:US
Mailing Address - Phone:785-626-3274
Mailing Address - Fax:785-626-3275
Practice Address - Street 1:418 MAIN ST
Practice Address - Street 2:
Practice Address - City:ATWOOD
Practice Address - State:KS
Practice Address - Zip Code:67730-1826
Practice Address - Country:US
Practice Address - Phone:785-626-3274
Practice Address - Fax:785-626-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-01569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty