Provider Demographics
NPI:1598012288
Name:BALANCED HEALTH FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:BALANCED HEALTH FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DURSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-553-9300
Mailing Address - Street 1:501 BOSTON POST RD STE 24
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3551
Mailing Address - Country:US
Mailing Address - Phone:203-553-9300
Mailing Address - Fax:203-553-9301
Practice Address - Street 1:501 BOSTON POST RD STE 24
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3551
Practice Address - Country:US
Practice Address - Phone:203-553-9300
Practice Address - Fax:203-553-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD100080329Medicare PIN