Provider Demographics
NPI:1437483831
Name:SALANCE CLINIC, INC.
Entity Type:Organization
Organization Name:SALANCE CLINIC, INC.
Other - Org Name:SALANCE CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OFFICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ATHENA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-731-4848
Mailing Address - Street 1:4255 BRYANT IRVIN RD STE 108
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4224
Mailing Address - Country:US
Mailing Address - Phone:817-731-4848
Mailing Address - Fax:817-731-4858
Practice Address - Street 1:4255 BRYANT IRVIN RD STE 108
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4224
Practice Address - Country:US
Practice Address - Phone:817-731-4848
Practice Address - Fax:817-731-4858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty