Provider Demographics
NPI:1356664882
Name:BACK IN BALANCE CHIROPRACTIC
Entity Type:Organization
Organization Name:BACK IN BALANCE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:WEED
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-890-6303
Mailing Address - Street 1:3163 E FAIRVIEW AVE
Mailing Address - Street 2:SUITE 155
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8098
Mailing Address - Country:US
Mailing Address - Phone:208-890-6303
Mailing Address - Fax:
Practice Address - Street 1:3163 E FAIRVIEW AVE
Practice Address - Street 2:SUITE 155
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8098
Practice Address - Country:US
Practice Address - Phone:208-890-6303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty