Provider Demographics
NPI:1619451077
Name:BACK IN BALANCE FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:BACK IN BALANCE FAMILY CHIROPRACTIC
Other - Org Name:BACK IN BALANCE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-694-5162
Mailing Address - Street 1:2311 WAKARUSA DR STE C
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-3350
Mailing Address - Country:US
Mailing Address - Phone:785-424-7384
Mailing Address - Fax:
Practice Address - Street 1:2311 WAKARUSA DR STE C
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-3350
Practice Address - Country:US
Practice Address - Phone:785-424-7384
Practice Address - Fax:833-300-9392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty