Provider Demographics
NPI:1295387504
Name:BACK IN BALANCE CHIROPRACTIC AND DAY SPA, LLC
Entity Type:Organization
Organization Name:BACK IN BALANCE CHIROPRACTIC AND DAY SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DACKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-238-9740
Mailing Address - Street 1:2006 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-2241
Mailing Address - Country:US
Mailing Address - Phone:386-238-9740
Mailing Address - Fax:
Practice Address - Street 1:2006 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-2241
Practice Address - Country:US
Practice Address - Phone:386-238-9740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty