Healthcare Provider Details

I. General information

NPI: 1770781908
Provider Name (Legal Business Name): BALANCED APPROACH CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SW 3RD ST SUITE D
LEES SUMMIT MO
64063-2211
US

IV. Provider business mailing address

500 SW 3RD ST SUITE D
LEES SUMMIT MO
64063-2211
US

V. Phone/Fax

Practice location:
  • Phone: 816-246-2663
  • Fax: 816-246-2614
Mailing address:
  • Phone: 816-246-2663
  • Fax: 816-246-2614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2004015447
License Number StateMO

VIII. Authorized Official

Name: DR. MITCHELL S SIMON
Title or Position: MANAGER
Credential: DC
Phone: 816-246-2663