Healthcare Provider Details

I. General information

NPI: 1437536208
Provider Name (Legal Business Name): BALANCED FLOW WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 N LASALLE 3RD FLOOR
CHICAGO IL
60654-5089
US

IV. Provider business mailing address

747 N. LASALLE 3RD FLOOR
CHICAGO IL
60654
US

V. Phone/Fax

Practice location:
  • Phone: 312-880-9697
  • Fax:
Mailing address:
  • Phone: 312-880-9697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012628
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012631
License Number StateIL

VIII. Authorized Official

Name: DR. NOLAN LEE
Title or Position: PARTNER
Credential: D.C.
Phone: 312-296-3569