Provider Demographics
NPI:1730102302
Name:BALFANZ, MICHAEL SCOTT (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:BALFANZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 29TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4589
Mailing Address - Country:US
Mailing Address - Phone:320-240-0300
Mailing Address - Fax:320-240-0303
Practice Address - Street 1:48 29TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4589
Practice Address - Country:US
Practice Address - Phone:320-240-0300
Practice Address - Fax:320-240-0303
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002233Medicare ID - Type UnspecifiedMEDICARE