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General NPI Number Information
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NPI Number | 1114183431
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Entity Type | Organization
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Legal Business Name | CREATIVE BIOLOGY, LLC
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Dates
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Enumeration Date | 08/06/2008
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 553 HAZARD AVE RAINBOW REMEDIES
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City | ENFIELD
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State | CT
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Zip | 06082-4704
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Country | US
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Telephone | 860-466-9072
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Fax |
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Provider Business Mailing Address
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Address Line | 553 HAZARD AVE RAINBOW REMEDIES
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City | ENFIELD
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State | CT
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Zip | 06082-4704
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Country | US
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Telephone | 860-466-9072
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CHRISTOS BALIS
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Credential | D.C., FASA
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Telephone | 860-466-9072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 001771
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License Number State | CT
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