Healthcare Provider Details

I. General information

NPI: 1598012288
Provider Name (Legal Business Name): BALANCED HEALTH FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BOSTON POST RD STE 24
ORANGE CT
06477-3551
US

IV. Provider business mailing address

501 BOSTON POST RD STE 24
ORANGE CT
06477-3551
US

V. Phone/Fax

Practice location:
  • Phone: 203-553-9300
  • Fax: 203-553-9301
Mailing address:
  • Phone: 203-553-9300
  • Fax: 203-553-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID DURSO
Title or Position: CHIROPRACTOR/OWNER
Credential: D.C.
Phone: 203-553-9300