Provider Demographics
NPI:1831703149
Name:BALANCED LIFE WELLNESS
Entity type:Organization
Organization Name:BALANCED LIFE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MCCURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-590-9310
Mailing Address - Street 1:12A BOARDWALK PL
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-2671
Mailing Address - Country:US
Mailing Address - Phone:864-723-3055
Mailing Address - Fax:
Practice Address - Street 1:12A BOARDWALK PL
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-2671
Practice Address - Country:US
Practice Address - Phone:864-723-3055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty