Provider Demographics
NPI:1205594744
Name:EQUILIBRIUM CHIROPRACTIC PLLC.
Entity type:Organization
Organization Name:EQUILIBRIUM CHIROPRACTIC PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-870-2522
Mailing Address - Street 1:931B S MAIN ST # 145
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-7439
Mailing Address - Country:US
Mailing Address - Phone:336-870-2522
Mailing Address - Fax:
Practice Address - Street 1:5006 HIGH POINT RD STE C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-6235
Practice Address - Country:US
Practice Address - Phone:336-870-2522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty