Provider Demographics
NPI:1861834541
Name:BALANCED SPINE AND HEALTH LLC
Entity Type:Organization
Organization Name:BALANCED SPINE AND HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNG KWANG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-995-9804
Mailing Address - Street 1:677 N NEW BALLAS RD STE 220
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6732
Mailing Address - Country:US
Mailing Address - Phone:314-995-9704
Mailing Address - Fax:314-995-9732
Practice Address - Street 1:677 N NEW BALLAS RD STE 220
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6732
Practice Address - Country:US
Practice Address - Phone:314-995-9704
Practice Address - Fax:314-995-9732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009021952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty