Provider Demographics
NPI:1336519099
Name:BALANCED SPINE CENTER, INC.
Entity Type:Organization
Organization Name:BALANCED SPINE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:EMILIO
Authorized Official - Last Name:PORTELA-BERRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-223-7227
Mailing Address - Street 1:11010 POINT NELLIE DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8663
Mailing Address - Country:US
Mailing Address - Phone:352-223-7227
Mailing Address - Fax:
Practice Address - Street 1:192 W HWY 50
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3078
Practice Address - Country:US
Practice Address - Phone:352-708-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty