Provider Demographics
NPI:1417503327
Name:BALANCED PATH, LLC
Entity Type:Organization
Organization Name:BALANCED PATH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:RUNDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-672-4699
Mailing Address - Street 1:210A W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:WI
Mailing Address - Zip Code:54736-1147
Mailing Address - Country:US
Mailing Address - Phone:715-672-4699
Mailing Address - Fax:715-672-4999
Practice Address - Street 1:210A W MAIN ST
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:WI
Practice Address - Zip Code:54736-1147
Practice Address - Country:US
Practice Address - Phone:715-672-4699
Practice Address - Fax:715-672-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty