Healthcare Provider Details

I. General information

NPI: 1861721144
Provider Name (Legal Business Name): BALANCED BODY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8121 MADISON BLVD STE 102
MADISON AL
35758-2018
US

IV. Provider business mailing address

104 OVERLEAF PT SW
HUNTSVILLE AL
35824-3102
US

V. Phone/Fax

Practice location:
  • Phone: 256-464-7260
  • Fax: 256-772-7066
Mailing address:
  • Phone: 256-464-7260
  • Fax: 256-772-7066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2286
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number2286
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number2286
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA CROCKETT
Title or Position: CEO
Credential:
Phone: 256-464-7260