Healthcare Provider Details

I. General information

NPI: 1811495203
Provider Name (Legal Business Name): WELL BALANCED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 N MUR LEN RD STE B
OLATHE KS
66062-1208
US

IV. Provider business mailing address

511 N MUR LEN RD STE B
OLATHE KS
66062-1208
US

V. Phone/Fax

Practice location:
  • Phone: 913-333-0618
  • Fax:
Mailing address:
  • Phone: 913-333-0618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-05660
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MADISON D GILBERT
Title or Position: OWNER/DC
Credential: DC
Phone: 913-333-0618