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General NPI Number Information
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NPI Number | 1033778451
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Entity Type | Organization
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Legal Business Name | BALANCED SPINE & WELLNESS, LLC
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 6705 W 41ST ST
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City | SIOUX FALLS
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State | SD
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Zip | 57106-1290
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Country | US
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Telephone | 605-636-5013
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Fax | 202-967-2307
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Provider Business Mailing Address
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Address Line | 2309 S SADIE AVE
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City | SIOUX FALLS
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State | SD
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Zip | 57106-7353
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Country | US
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Telephone | 605-681-4173
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. TELISHIA DEVERICKS
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Credential | DC
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Telephone | 605-681-4173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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