Provider Demographics
NPI:1902197478
Name:MAXIMUM BALANCE LLC
Entity Type:Organization
Organization Name:MAXIMUM BALANCE LLC
Other - Org Name:MAXIMUM BALANCE KINESIOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-542-2360
Mailing Address - Street 1:7374 W OHIO AVE
Mailing Address - Street 2:APT 301
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-4989
Mailing Address - Country:US
Mailing Address - Phone:636-542-2360
Mailing Address - Fax:
Practice Address - Street 1:6950 E BELLEVIEW AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1618
Practice Address - Country:US
Practice Address - Phone:636-542-2360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-6676261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center