Healthcare Provider Details

I. General information

NPI: 1427115773
Provider Name (Legal Business Name): BALANCE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6750 E MAIN ST STE 108
MESA AZ
85205-9049
US

IV. Provider business mailing address

6750 E MAIN ST STE 108
MESA AZ
85205-9049
US

V. Phone/Fax

Practice location:
  • Phone: 480-985-0720
  • Fax:
Mailing address:
  • Phone: 480-985-0720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7764
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4447
License Number StateAZ

VIII. Authorized Official

Name: DR. SAM HALLOWS
Title or Position: OWNER
Credential: DC
Phone: 480-985-0720