Provider Demographics
NPI:1497904577
Name:BACK N BALANCE INC.
Entity Type:Organization
Organization Name:BACK N BALANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:NA
Authorized Official - Phone:727-733-6501
Mailing Address - Street 1:1059 BROADWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698
Mailing Address - Country:US
Mailing Address - Phone:727-733-6501
Mailing Address - Fax:727-733-6701
Practice Address - Street 1:1059 BROADWAY
Practice Address - Street 2:SUITE C
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698
Practice Address - Country:US
Practice Address - Phone:727-733-6501
Practice Address - Fax:727-733-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3980Medicare UPIN
FLK3980Medicare PIN