Provider Demographics
NPI:1093157463
Name:BALANCED SPINE AND REHABILITAION CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:BALANCED SPINE AND REHABILITAION CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:METTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-214-4327
Mailing Address - Street 1:1100 SE CENTURY DR
Mailing Address - Street 2:D
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-3284
Mailing Address - Country:US
Mailing Address - Phone:816-655-2162
Mailing Address - Fax:
Practice Address - Street 1:3505 NW NAUTICAL CT
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-7029
Practice Address - Country:US
Practice Address - Phone:605-214-4327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013013303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty