Provider Demographics
NPI:1700801594
Name:BALANCE MULTICARE, PLC
Entity Type:Organization
Organization Name:BALANCE MULTICARE, PLC
Other - Org Name:HEALTHSOURCE CHIROPRACTIC & PROGRESSIVE REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:928-778-7996
Mailing Address - Street 1:936 12TH PL
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1436
Mailing Address - Country:US
Mailing Address - Phone:928-778-7996
Mailing Address - Fax:928-442-3324
Practice Address - Street 1:936 12TH PL
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1436
Practice Address - Country:US
Practice Address - Phone:928-778-7996
Practice Address - Fax:928-442-3324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ76782Medicare ID - Type UnspecifiedGIN