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General NPI Number Information
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NPI Number | 1336519099
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Entity Type | Organization
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Legal Business Name | BALANCED SPINE CENTER, INC.
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Dates
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Enumeration Date | 10/06/2015
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Last Update Date | 02/01/2016
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Provider Practice Location Address
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Address Line | 192 W HWY 50
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City | CLERMONT
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State | FL
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Zip | 34711-3078
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Country | US
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Telephone | 352-708-5333
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Fax |
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Provider Business Mailing Address
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Address Line | 11010 POINT NELLIE DR
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City | CLERMONT
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State | FL
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Zip | 34711-8663
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Country | US
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Telephone | 352-223-7227
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC MEDICINE
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Name | DR. JOSE EMILIO PORTELA-BERRIOS
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Credential | D.C.
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Telephone | 352-223-7227
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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 | CH11376
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License Number State | FL
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