Provider Demographics
NPI:1619231255
Name:BALANCED BODYWORK CLINIC
Entity Type:Organization
Organization Name:BALANCED BODYWORK CLINIC
Other - Org Name:CUYAHOGA HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BIONDILLO
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:440-539-2014
Mailing Address - Street 1:900 VINEYARD DR
Mailing Address - Street 2:402
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-3390
Mailing Address - Country:US
Mailing Address - Phone:440-539-2014
Mailing Address - Fax:
Practice Address - Street 1:203 E ROYALTON RD
Practice Address - Street 2:#7
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-4037
Practice Address - Country:US
Practice Address - Phone:440-539-2014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty