Provider Demographics
NPI:1184664500
Name:THE BODY BALANCING CENTER PC
Entity Type:Organization
Organization Name:THE BODY BALANCING CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSSAMANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-817-7788
Mailing Address - Street 1:1410 INCARNATION DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-5708
Mailing Address - Country:US
Mailing Address - Phone:434-817-7788
Mailing Address - Fax:
Practice Address - Street 1:1410 INCARNATION DR
Practice Address - Street 2:SUITE 204
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-5708
Practice Address - Country:US
Practice Address - Phone:434-817-7788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09791Medicare ID - Type Unspecified