Provider Demographics
NPI:1518364975
Name:5280 BALANCED HEALTH CENTER LLC
Entity Type:Organization
Organization Name:5280 BALANCED HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-915-7997
Mailing Address - Street 1:5690 DTC BLVD
Mailing Address - Street 2:SUITE 140E
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3232
Mailing Address - Country:US
Mailing Address - Phone:303-915-7997
Mailing Address - Fax:
Practice Address - Street 1:5690 DTC BLVD
Practice Address - Street 2:SUITE 140E
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3232
Practice Address - Country:US
Practice Address - Phone:303-915-7997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0006640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty