Provider Demographics
NPI:1265465058
Name:BALANCED SPINE LLC
Entity Type:Organization
Organization Name:BALANCED SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-369-1040
Mailing Address - Street 1:22525 SE 64TH PL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5383
Mailing Address - Country:US
Mailing Address - Phone:425-369-1040
Mailing Address - Fax:425-369-1041
Practice Address - Street 1:22525 SE 64TH PL
Practice Address - Street 2:SUITE 110
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5383
Practice Address - Country:US
Practice Address - Phone:425-369-1040
Practice Address - Fax:425-369-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU89785Medicare UPIN