Healthcare Provider Details

I. General information

NPI: 1730102302
Provider Name (Legal Business Name): MICHAEL SCOTT BALFANZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 29TH AVE N
SAINT CLOUD MN
56303-4589
US

IV. Provider business mailing address

48 29TH AVE N
SAINT CLOUD MN
56303-4589
US

V. Phone/Fax

Practice location:
  • Phone: 320-240-0300
  • Fax: 320-240-0303
Mailing address:
  • Phone: 320-240-0300
  • Fax: 320-240-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3548
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: