MEDICARE: BALANCED CHIROPRACTIC

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	:	1720470867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCED CHIROPRACTIC

Provider Business Mailing Address
First Line	:	400 N MAIN ST
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52801-1417
Country	:	US
Telephone Number	:	563-324-8888
Fax Number	:	563-324-8888

Provider Business Practice Location Address
First Line	:	400 N MAIN ST
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52801-1417
Country	:	US
Telephone Number	:	563-324-8888
Fax Number	:	563-324-8888

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JESSICA JOHNSTONE
Credential	:	DC
Telephone Number	:	563-324-8888

Provider Enumeration Date	:	02/26/2015
Last Update Date	:	02/26/2015

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Directions to “BALANCED CHIROPRACTIC ” Practice Location

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