Provider Demographics
NPI:1790179976
Name:BALANCED BODY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BALANCED BODY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ACCARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:331-212-6962
Mailing Address - Street 1:1231 FARMINGTON LAKES DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-5109
Mailing Address - Country:US
Mailing Address - Phone:331-212-6962
Mailing Address - Fax:630-429-9276
Practice Address - Street 1:1231 FARMINGTON LAKES DR
Practice Address - Street 2:SUITE 101
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-5109
Practice Address - Country:US
Practice Address - Phone:331-212-6962
Practice Address - Fax:630-429-9276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty