Provider Demographics
NPI:1104041706
Name:BACK IN BALANCE CHIROPRACTIC & ACUPUNCTURE CENTER, LTD.
Entity Type:Organization
Organization Name:BACK IN BALANCE CHIROPRACTIC & ACUPUNCTURE CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MCPOLIN
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-588-8270
Mailing Address - Street 1:518 HILLGROVE AVE STE 275
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1460
Mailing Address - Country:US
Mailing Address - Phone:708-588-8270
Mailing Address - Fax:708-588-8271
Practice Address - Street 1:518 HILLGROVE AVE STE 275
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1460
Practice Address - Country:US
Practice Address - Phone:708-588-8270
Practice Address - Fax:708-588-8271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38009671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632424OtherBCBS OF IL ID #
IL01632424OtherBCBS OF IL ID #