Provider Demographics
NPI:1740407907
Name:BALANCED HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:BALANCED HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-978-3110
Mailing Address - Street 1:2011 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3965
Mailing Address - Country:US
Mailing Address - Phone:636-978-3110
Mailing Address - Fax:636-980-1059
Practice Address - Street 1:2011 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-3965
Practice Address - Country:US
Practice Address - Phone:636-978-3110
Practice Address - Fax:636-980-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006000335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000014894Medicare PIN