Provider Demographics
NPI:1932499506
Name:BALANCE KINETICS, LLC
Entity Type:Organization
Organization Name:BALANCE KINETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABEL
Authorized Official - Middle Name:COSTAS
Authorized Official - Last Name:BORROMEO
Authorized Official - Suffix:V
Authorized Official - Credentials:DC
Authorized Official - Phone:540-550-3656
Mailing Address - Street 1:125 PROSPERITY DRIVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602
Mailing Address - Country:US
Mailing Address - Phone:540-323-7957
Mailing Address - Fax:540-323-7956
Practice Address - Street 1:125 PROSPERITY DRIVE
Practice Address - Street 2:SUITE 700
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602
Practice Address - Country:US
Practice Address - Phone:540-323-7957
Practice Address - Fax:540-323-7956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556472111NR0400X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty