Healthcare Provider Details

I. General information

NPI: 1720225675
Provider Name (Legal Business Name): BALANCED HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N MAIN ST
PECULIAR MO
64078-2522
US

IV. Provider business mailing address

215 N MAIN ST
PECULIAR MO
64078-2522
US

V. Phone/Fax

Practice location:
  • Phone: 816-779-3220
  • Fax: 816-974-1613
Mailing address:
  • Phone: 816-779-3220
  • Fax: 816-974-1613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2008011984
License Number StateMO

VIII. Authorized Official

Name: DR. JENNIFER R WELCH
Title or Position: PRESIDENT
Credential: D.C.
Phone: 816-779-3220