MEDICARE: BODY IN BALANCE CHIROPRACTIC & WELLNESS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1629659420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY IN BALANCE CHIROPRACTIC & WELLNESS, PC

Provider Business Mailing Address
First Line	:	1002 14TH ST SE
Second Line	:
City	:	WATERTOWN
State	:	SD
Zip	:	57201-5328
Country	:	US
Telephone Number	:	605-878-2639
Fax Number	:	605-878-2640

Provider Business Practice Location Address
First Line	:	1002 14TH ST SE
Second Line	:
City	:	WATERTOWN
State	:	SD
Zip	:	57201-5328
Country	:	US
Telephone Number	:	605-878-2639
Fax Number	:	605-878-2640

Authorized Official
Title or Position	:	OWNER
Name	:	ALLISON A DARGATZ
Credential	:	DC
Telephone Number	:	605-878-2639

Provider Enumeration Date	:	04/14/2021
Last Update Date	:	06/24/2021

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