Provider Demographics
NPI:1184852295
Name:COMMUNITY CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:COMMUNITY CHIROPRACTIC CLINIC LLC
Other - Org Name:BALANCED HEALING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-262-0339
Mailing Address - Street 1:2 WORTH CIR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4304
Mailing Address - Country:US
Mailing Address - Phone:423-262-0339
Mailing Address - Fax:423-262-0340
Practice Address - Street 1:2 WORTH CIR
Practice Address - Street 2:SUITE 3
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4304
Practice Address - Country:US
Practice Address - Phone:423-262-0339
Practice Address - Fax:423-262-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-26
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty