Provider Demographics
NPI:1831314715
Name:INNER BALANCE CHIROPRACTIC
Entity Type:Organization
Organization Name:INNER BALANCE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-482-2003
Mailing Address - Street 1:344 FULLER RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3647
Mailing Address - Country:US
Mailing Address - Phone:518-482-2003
Mailing Address - Fax:
Practice Address - Street 1:344 FULLER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3647
Practice Address - Country:US
Practice Address - Phone:518-482-2003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009755-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10095460OtherCDPHP
NYCO9755-2OtherWORKERS COMPENSATION
NYCO9755-2OtherWORKERS COMPENSATION
NYU83271Medicare UPIN