Provider Demographics
NPI:1639781578
Name:BALANCED LIFE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BALANCED LIFE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINMAAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-215-1785
Mailing Address - Street 1:3801 W 34TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-4310
Mailing Address - Country:US
Mailing Address - Phone:605-215-1785
Mailing Address - Fax:605-215-6588
Practice Address - Street 1:3801 W 34TH ST STE 105
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-4310
Practice Address - Country:US
Practice Address - Phone:605-215-1785
Practice Address - Fax:605-215-6588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty