Healthcare Provider Details

I. General information

NPI: 1851789838
Provider Name (Legal Business Name): LIFE BALANCE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7695 CHURCH RANCH BLVD
WESTMINSTER CO
80021-5544
US

IV. Provider business mailing address

3220 W 62ND AVE
DENVER CO
80221-1907
US

V. Phone/Fax

Practice location:
  • Phone: 303-635-2273
  • Fax: 303-635-1225
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5110
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number5110
License Number StateCO

VIII. Authorized Official

Name: DR. SHANE RYAN KOKOSZKA
Title or Position: OWNER
Credential: D.C. C.AC. FIAMA
Phone: 303-635-2273