Provider Demographics
NPI:1497413348
Name:BALANCED CHIROPRACTIC
Entity Type:Organization
Organization Name:BALANCED CHIROPRACTIC
Other - Org Name:BALANCED MOVEMENT CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JESPERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-466-4600
Mailing Address - Street 1:16730 N MARKETPLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-7909
Mailing Address - Country:US
Mailing Address - Phone:208-466-4600
Mailing Address - Fax:
Practice Address - Street 1:16730 N MARKETPLACE BLVD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-7909
Practice Address - Country:US
Practice Address - Phone:208-466-4600
Practice Address - Fax:208-461-9236
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALANCED CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-07
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty