Provider Demographics
NPI:1114183431
Name:CREATIVE BIOLOGY, LLC
Entity Type:Organization
Organization Name:CREATIVE BIOLOGY, LLC
Other - Org Name:RAINBOW REMEDIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOS
Authorized Official - Middle Name:
Authorized Official - Last Name:BALIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FASA
Authorized Official - Phone:860-466-9072
Mailing Address - Street 1:553 HAZARD AVE
Mailing Address - Street 2:RAINBOW REMEDIES
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4704
Mailing Address - Country:US
Mailing Address - Phone:860-466-9072
Mailing Address - Fax:
Practice Address - Street 1:553 HAZARD AVE
Practice Address - Street 2:RAINBOW REMEDIES
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4704
Practice Address - Country:US
Practice Address - Phone:860-466-9072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001771111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty