Provider Demographics
NPI:1568703668
Name:LIFE IN BALANCE FAMILY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:LIFE IN BALANCE FAMILY CHIROPRACTIC, PLLC
Other - Org Name:LIFE IN BALANCE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIAN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-333-4040
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-0203
Mailing Address - Country:US
Mailing Address - Phone:425-333-4040
Mailing Address - Fax:
Practice Address - Street 1:31722 W. EUGENE ST.
Practice Address - Street 2:STE 6
Practice Address - City:CARNATION
Practice Address - State:WA
Practice Address - Zip Code:98014-0203
Practice Address - Country:US
Practice Address - Phone:425-333-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty