Provider Demographics
NPI:1578757852
Name:BALANCED CHIROPRACTIC AND NUTRITION, PA
Entity Type:Organization
Organization Name:BALANCED CHIROPRACTIC AND NUTRITION, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIPPA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:361-991-4672
Mailing Address - Street 1:5309 WILLIAMS DR STE B
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4638
Mailing Address - Country:US
Mailing Address - Phone:361-991-4672
Mailing Address - Fax:361-991-4673
Practice Address - Street 1:5309 WILLIAMS DR STE B
Practice Address - Street 2:
Practice Address - City:CORP CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4638
Practice Address - Country:US
Practice Address - Phone:361-991-4672
Practice Address - Fax:361-991-4673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV08821Medicare UPIN