Healthcare Provider Details

I. General information

NPI: 1578757852
Provider Name (Legal Business Name): BALANCED CHIROPRACTIC AND NUTRITION, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5309 WILLIAMS DR STE B
CORP CHRISTI TX
78411-4638
US

IV. Provider business mailing address

5309 WILLIAMS DR STE B
CORPUS CHRISTI TX
78411-4638
US

V. Phone/Fax

Practice location:
  • Phone: 361-991-4672
  • Fax: 361-991-4673
Mailing address:
  • Phone: 361-991-4672
  • Fax: 361-991-4673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number10187
License Number StateTX

VIII. Authorized Official

Name: DR. ROSE KNIPPA
Title or Position: OWNER/PRESIDENT
Credential: D.C.
Phone: 361-991-4672