MEDICARE: DR. ROLANDE D BALAN DC

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	038007681	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750378006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROLANDE D BALAN DC

Provider Business Mailing Address
First Line	:	1304 E 47TH ST STE 201
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-4695
Country	:	US
Telephone Number	:	773-493-7034
Fax Number	:	773-493-5521

Provider Business Practice Location Address
First Line	:	1304 E 47TH ST STE 201
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-4695
Country	:	US
Telephone Number	:	773-493-7034
Fax Number	:	773-493-5521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	01/11/2023

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