Provider Demographics
NPI:1700108495
Name:BALANCED HEALTH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BALANCED HEALTH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:LOVDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-245-0807
Mailing Address - Street 1:6831 JEWEL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-2823
Mailing Address - Country:US
Mailing Address - Phone:907-245-0807
Mailing Address - Fax:907-245-0809
Practice Address - Street 1:6831 JEWEL LAKE RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-2823
Practice Address - Country:US
Practice Address - Phone:907-245-0807
Practice Address - Fax:907-245-0809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty