Provider Demographics
NPI:1336656701
Name:BALANCED FLOW MEDICAL LLC
Entity Type:Organization
Organization Name:BALANCED FLOW MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALINOWSKA HERTSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-880-9697
Mailing Address - Street 1:2325 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5369
Mailing Address - Country:US
Mailing Address - Phone:312-880-9697
Mailing Address - Fax:
Practice Address - Street 1:2325 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5369
Practice Address - Country:US
Practice Address - Phone:312-880-9697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-06
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
IL038012628208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1225442502Medicaid