Provider Demographics
NPI:1710437652
Name:BALANCED CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BALANCED CHIROPRACTIC LLC
Other - Org Name:BALANCED CHIROPRACTIC LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-842-2622
Mailing Address - Street 1:6729 LAKE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:WI
Mailing Address - Zip Code:53598-9701
Mailing Address - Country:US
Mailing Address - Phone:608-842-2622
Mailing Address - Fax:
Practice Address - Street 1:6729 LAKE RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:WI
Practice Address - Zip Code:53598-9701
Practice Address - Country:US
Practice Address - Phone:812-212-2043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5116-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1710437652OtherNPI