Provider Demographics
NPI:1629282348
Name:BALANCE SPINE AND DISC CENTER LLC
Entity Type:Organization
Organization Name:BALANCE SPINE AND DISC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:HAKAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-545-4000
Mailing Address - Street 1:9 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2418
Mailing Address - Country:US
Mailing Address - Phone:732-545-4000
Mailing Address - Fax:732-545-4001
Practice Address - Street 1:9 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2418
Practice Address - Country:US
Practice Address - Phone:732-545-4000
Practice Address - Fax:732-545-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00526400111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty