Healthcare Provider Details

I. General information

NPI: 1831703149
Provider Name (Legal Business Name): BALANCED LIFE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12A BOARDWALK PL
SENECA SC
29678-2671
US

IV. Provider business mailing address

12A BOARDWALK PL
SENECA SC
29678-2671
US

V. Phone/Fax

Practice location:
  • Phone: 864-723-3055
  • Fax:
Mailing address:
  • Phone: 864-723-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREN DENISE MCCURLEY
Title or Position: SOLE MBR
Credential: DC
Phone: 864-590-9310