Provider Demographics
NPI:1942694823
Name:STAMFORD BALANCE, LLC
Entity Type:Organization
Organization Name:STAMFORD BALANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:POULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-355-2830
Mailing Address - Street 1:144 MORGAN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5433
Mailing Address - Country:US
Mailing Address - Phone:203-355-2830
Mailing Address - Fax:203-405-8848
Practice Address - Street 1:144 MORGAN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5433
Practice Address - Country:US
Practice Address - Phone:203-355-2830
Practice Address - Fax:203-405-8848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty