Healthcare Provider Details

I. General information

NPI: 1649831140
Provider Name (Legal Business Name): BALANCE BY CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 BRANDON AVE
SPRINGFIELD VA
22150-2610
US

IV. Provider business mailing address

269 S PICKETT ST APT 402
ALEXANDRIA VA
22304-4734
US

V. Phone/Fax

Practice location:
  • Phone: 703-544-9494
  • Fax:
Mailing address:
  • Phone: 248-535-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HEATHER HUNTER
Title or Position: OPERATIONS MANAGER
Credential: DC
Phone: 248-535-2012