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General NPI Number Information
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NPI Number | 1174778880
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Entity Type | Organization
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Legal Business Name | BACK INTO BALANCE
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 11/21/2008
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Provider Practice Location Address
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Address Line | 433 STATE STREET SOUTH SUITE 6
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City | KIRKLAND
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State | WA
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Zip | 98033-6615
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Country | US
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Telephone | 425-827-0334
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Fax | 425-284-6884
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Provider Business Mailing Address
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Address Line | 433 STATE STREET SOUTH SUITE 6
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City | KIRKLAND
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State | WA
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Zip | 98033-6615
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Country | US
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Telephone | 425-827-0334
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Fax | 425-284-6884
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DAVID JOHN BARRY
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Credential | ND, DC
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Telephone | 425-827-0334
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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 | CH00034760
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License Number State | WA
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