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General NPI Number Information
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NPI Number | 1144641978
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Entity Type | Organization
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Legal Business Name | INNER BALANCE FAMILY CHIROPRACTIC PLC
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Dates
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Enumeration Date | 12/20/2013
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Last Update Date | 01/06/2014
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Provider Practice Location Address
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Address Line | 4444 W 76TH ST SUITE 300
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City | EDINA
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State | MN
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Zip | 55435-5173
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Country | US
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Telephone | 612-481-4457
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Fax |
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Provider Business Mailing Address
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Address Line | 8654 POPLAR BRIDGE CURV
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City | BLOOMINGTON
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State | MN
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Zip | 55437-1441
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Country | US
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Telephone | 612-481-4457
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. DANIELLE KLICK
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Credential | D.C.
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Telephone | 612-481-4457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5764
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License Number State | MN
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