Provider Demographics
NPI:1164600219
Name:BALANCE CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:BALANCE CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SCHAEFER BRONSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-230-2343
Mailing Address - Street 1:445 STATE ROAD 13
Mailing Address - Street 2:SUITE 9
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3838
Mailing Address - Country:US
Mailing Address - Phone:904-230-2343
Mailing Address - Fax:904-230-2352
Practice Address - Street 1:445 STATE ROAD 13
Practice Address - Street 2:SUITE 9
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-3838
Practice Address - Country:US
Practice Address - Phone:904-230-2343
Practice Address - Fax:904-230-2352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70119EMedicare UPIN