Provider Demographics
NPI:1508192345
Name:AUDIOLOGY AND BALANCE SERVICES
Entity Type:Organization
Organization Name:AUDIOLOGY AND BALANCE SERVICES
Other - Org Name:BALANCED EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOLOGIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CHINN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:479-254-0011
Mailing Address - Street 1:1501 SE WALTON BLVD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3734
Mailing Address - Country:US
Mailing Address - Phone:479-254-0011
Mailing Address - Fax:479-254-0710
Practice Address - Street 1:1501 SE WALTON BLVD
Practice Address - Street 2:SUITE 119
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3734
Practice Address - Country:US
Practice Address - Phone:479-254-0011
Practice Address - Fax:479-254-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA-170237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
640004342OtherRAILROAD MEDICARE
AR143987720Medicaid
MO335401501Medicaid
AR143987720Medicaid