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General NPI Number Information
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NPI Number | 1275771883
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Entity Type | Organization
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Legal Business Name | BODY BALANCE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 08/03/2009
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Provider Practice Location Address
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Address Line | 944 S HIGHWAY 89 # 91
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City | LOGAN
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State | UT
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Zip | 84321-5436
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Country | US
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Telephone | 435-755-3432
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Fax |
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Provider Business Mailing Address
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Address Line | 4655 MADISON AVE
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-3007
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | BENJAMIN BENONI JENSEN
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Credential | D.C.
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Telephone | 435-770-4043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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