Healthcare Provider Details

I. General information

NPI: 1619116415
Provider Name (Legal Business Name): BALANCED LIVING CHIROPRACTIC & WELLNESS CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 N CORPORATE CIR STE D
GRAYSLAKE IL
60030-7813
US

IV. Provider business mailing address

1015 N CORPORATE CIR STE D
GRAYSLAKE IL
60030-7813
US

V. Phone/Fax

Practice location:
  • Phone: 847-599-9900
  • Fax: 847-599-9901
Mailing address:
  • Phone: 847-599-9900
  • Fax: 847-599-9901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038010512
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JODIE L SCHULTZ
Title or Position: PRESIDENT
Credential: D.C.
Phone: 847-599-9900