Provider Demographics
NPI:1497916506
Name:WELL BALANCED CHIROPRACTIC PC
Entity type:Organization
Organization Name:WELL BALANCED CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANKUR
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAKASH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-579-2858
Mailing Address - Street 1:113 W 78TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6755
Mailing Address - Country:US
Mailing Address - Phone:212-579-2858
Mailing Address - Fax:212-579-2853
Practice Address - Street 1:113 W 78TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6755
Practice Address - Country:US
Practice Address - Phone:212-579-2858
Practice Address - Fax:212-579-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX7N041Medicare PIN