Healthcare Provider Details

I. General information

NPI: 1982488045
Provider Name (Legal Business Name): BALANCED FLOW LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 W NORTH AVE
CHICAGO IL
60647-5369
US

IV. Provider business mailing address

2325 W NORTH AVE
CHICAGO IL
60647-5369
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 TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DOMINIKA MALINOWSKA HERTSBERG
Title or Position: OWNER
Credential: DC
Phone: 312-880-9697