Provider Demographics
NPI:1942647284
Name:TIMBERLANE CHIROPRACTIC
Entity Type:Organization
Organization Name:TIMBERLANE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BAMBI
Authorized Official - Middle Name:BURNETTE
Authorized Official - Last Name:BALA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-270-8890
Mailing Address - Street 1:1996 N FUTURE TER
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-9341
Mailing Address - Country:US
Mailing Address - Phone:352-270-8890
Mailing Address - Fax:352-270-8890
Practice Address - Street 1:1996 N FUTURE TER
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9341
Practice Address - Country:US
Practice Address - Phone:352-270-8890
Practice Address - Fax:352-270-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty