Provider Demographics
NPI:1982939674
Name:BACK TO BALANCE LLC
Entity Type:Organization
Organization Name:BACK TO BALANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWEET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-821-6920
Mailing Address - Street 1:3176 STATE ROUTE 27
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824
Mailing Address - Country:US
Mailing Address - Phone:732-821-6920
Mailing Address - Fax:732-821-7020
Practice Address - Street 1:3176 STATE ROUTE 27
Practice Address - Street 2:SUITE 1C
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1514
Practice Address - Country:US
Practice Address - Phone:732-821-6920
Practice Address - Fax:732-821-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00646900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty