Healthcare Provider Details

I. General information

NPI: 1013289735
Provider Name (Legal Business Name): BALANCE HEALTH & INJURY CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 NE BURNSIDE RD STE 301
GRESHAM OR
97030-5705
US

IV. Provider business mailing address

1217 NE BURNSIDE RD SUITE 301
GRESHAM OR
97030-5705
US

V. Phone/Fax

Practice location:
  • Phone: 503-492-2625
  • Fax: 503-492-2355
Mailing address:
  • Phone: 503-492-2625
  • Fax: 503-492-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3243
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00635
License Number StateOR

VIII. Authorized Official

Name: DR. DANIEL LEONARD DESJARDINS
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 503-492-2625