Provider Demographics
NPI:1902187149
Name:COMPLETE BALANCE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:COMPLETE BALANCE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-293-3616
Mailing Address - Street 1:1967 SPRUCE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2624
Mailing Address - Country:US
Mailing Address - Phone:563-293-3616
Mailing Address - Fax:
Practice Address - Street 1:1967 SPRUCE HILLS DR
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2624
Practice Address - Country:US
Practice Address - Phone:563-293-3616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU81111Medicare UPIN