Provider Demographics
NPI:1780955740
Name:BODY IN BALANCE HEALTHCARE
Entity type:Organization
Organization Name:BODY IN BALANCE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:601-622-2998
Mailing Address - Street 1:5472 WATKINS DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-2000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5472 WATKINS DR
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-2000
Practice Address - Country:US
Practice Address - Phone:601-622-2998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1177111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty