Provider Demographics
NPI:1326317504
Name:BALANCE PROSTHETICS AND ORTHOTICS INC
Entity Type:Organization
Organization Name:BALANCE PROSTHETICS AND ORTHOTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHALOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-300-8873
Mailing Address - Street 1:3601 CHICHESTER AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:UPPER CHICHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19061-3149
Mailing Address - Country:US
Mailing Address - Phone:484-489-1006
Mailing Address - Fax:484-489-1001
Practice Address - Street 1:3601 CHICHESTER AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:UPPER CHICHESTER
Practice Address - State:PA
Practice Address - Zip Code:19061-3149
Practice Address - Country:US
Practice Address - Phone:484-489-1006
Practice Address - Fax:484-489-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-18
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACPO01938335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102697184 0001Medicaid
MD2258099 00Medicaid
DE1326317504Medicaid
DE1326317504Medicaid