Provider Demographics
NPI:1952754095
Name:BALANCE MEDICAL, LLC
Entity Type:Organization
Organization Name:BALANCE MEDICAL, LLC
Other - Org Name:BALANCE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARLOCK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:850-475-2676
Mailing Address - Street 1:5559 N DAVIS HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2048
Mailing Address - Country:US
Mailing Address - Phone:850-475-2676
Mailing Address - Fax:850-475-2679
Practice Address - Street 1:5559 N DAVIS HWY
Practice Address - Street 2:SUITE B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2048
Practice Address - Country:US
Practice Address - Phone:850-475-2676
Practice Address - Fax:850-475-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7173111N00000X
FL60612208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty