Provider Demographics
NPI:1982487583
Name:SIMPLY BALANCED CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SIMPLY BALANCED CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-680-5873
Mailing Address - Street 1:2535 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:SUITE 203 BOX #139
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118
Mailing Address - Country:US
Mailing Address - Phone:318-828-1564
Mailing Address - Fax:
Practice Address - Street 1:635 BERT KOUNS INDUSTRIAL LOOP STE 400
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-5704
Practice Address - Country:US
Practice Address - Phone:318-828-1564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty