Provider Demographics
NPI:1689860686
Name:BALANCED CARE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BALANCED CARE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JENA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:KITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-768-4455
Mailing Address - Street 1:12049 S STRANG LINE RD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-5256
Mailing Address - Country:US
Mailing Address - Phone:913-768-4455
Mailing Address - Fax:913-393-3729
Practice Address - Street 1:12049 S STRANG LINE RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-5256
Practice Address - Country:US
Practice Address - Phone:913-768-4455
Practice Address - Fax:913-393-3729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP002997828OtherMEDICARE RR
KS36135016OtherBCBS PROVIDER #
KS36098018OtherBCBS GROUP BILLING #
KSP002997828OtherMEDICARE RR