Provider Demographics
NPI:1700432069
Name:BALANCED LIFE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BALANCED LIFE CHIROPRACTIC, LLC
Other - Org Name:BALANCED LIFE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MYKOL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSTARICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-659-7140
Mailing Address - Street 1:606 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-3202
Mailing Address - Country:US
Mailing Address - Phone:303-659-7140
Mailing Address - Fax:
Practice Address - Street 1:606 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-3202
Practice Address - Country:US
Practice Address - Phone:303-659-7140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1326600420OtherNPI