Provider Demographics
NPI:1750986014
Name:BACK IN BALANCE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BACK IN BALANCE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-806-5745
Mailing Address - Street 1:59 POND ST APT A
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2064
Mailing Address - Country:US
Mailing Address - Phone:781-806-5745
Mailing Address - Fax:
Practice Address - Street 1:59 POND ST APT A
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-2064
Practice Address - Country:US
Practice Address - Phone:781-806-5745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center