Provider Demographics
NPI:1396724480
Name:BALANCED LIVING CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:BALANCED LIVING CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-832-1818
Mailing Address - Street 1:2140 EGGERT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2055
Mailing Address - Country:US
Mailing Address - Phone:716-832-1818
Mailing Address - Fax:716-832-7815
Practice Address - Street 1:2140 EGGERT RD
Practice Address - Street 2:SUITE B
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-2055
Practice Address - Country:US
Practice Address - Phone:716-832-1818
Practice Address - Fax:716-832-7815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010360-1 X010361-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU90359Medicare UPIN
NYAA1246Medicare ID - Type UnspecifiedBALANCED LIVING CHIROPRAC
NYU90360Medicare UPIN
NYDD1250Medicare ID - Type UnspecifiedKEVIN P. PHALEN, DC
NYDD1251Medicare ID - Type UnspecifiedSTEVEN R. NIEMIEC, DC