Provider Demographics
NPI:1518377605
Name:LIFE BALANCE CHIROPRACTIC & WELLNESS, LLC
Entity Type:Organization
Organization Name:LIFE BALANCE CHIROPRACTIC & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:CHRISTIN
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-868-8617
Mailing Address - Street 1:1300 E 66TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2684
Mailing Address - Country:US
Mailing Address - Phone:612-868-8617
Mailing Address - Fax:
Practice Address - Street 1:1300 E 66TH ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2684
Practice Address - Country:US
Practice Address - Phone:612-868-8617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1669811097Medicare PIN