Provider Demographics
NPI:1912367582
Name:PERFECTBALANCE MD SC
Entity Type:Organization
Organization Name:PERFECTBALANCE MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KINDRED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-922-1446
Mailing Address - Street 1:7720 N GRAND PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-9242
Mailing Address - Country:US
Mailing Address - Phone:309-922-1446
Mailing Address - Fax:
Practice Address - Street 1:7720 N GRAND PRAIRIE DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-9242
Practice Address - Country:US
Practice Address - Phone:309-922-1446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086752208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty