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General NPI Number Information
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NPI Number | 1225302557
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Entity Type | Organization
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Legal Business Name | IDAEL BALANCE, INC
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 6800 HERITAGE PKWY STE 200
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City | ROCKWALL
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State | TX
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Zip | 75087-8746
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Country | US
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Telephone | 972-463-9100
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Fax | 972-463-9109
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Provider Business Mailing Address
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Address Line | 6800 HERITAGE PKWY STE 200
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City | ROCKWALL
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State | TX
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Zip | 75087-8746
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Country | US
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Telephone | 972-463-9100
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Fax | 972-463-9109
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Authorized Official
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Title or Position | OWNER / PROVIDER
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Name | DR. JENNA M WEBSTER
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Credential | DC
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Telephone | 972-463-9100
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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 | 11542
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License Number State | TX
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