Provider Demographics
NPI:1720338478
Name:COLUMBIA BALANCE & DIZZINESS CENTER LLC
Entity Type:Organization
Organization Name:COLUMBIA BALANCE & DIZZINESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:N
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:573-818-3474
Mailing Address - Street 1:2401 BERNADETTE DR
Mailing Address - Street 2:STE 202
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4672
Mailing Address - Country:US
Mailing Address - Phone:573-818-3474
Mailing Address - Fax:
Practice Address - Street 1:2401 BERNADETTE DR
Practice Address - Street 2:STE 202
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4672
Practice Address - Country:US
Practice Address - Phone:573-818-3474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy