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General NPI Number Information
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NPI Number | 1407024599
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Entity Type | Organization
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Legal Business Name | BALANCED ROCK CHIROPRACTIC INC
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 5525 N UNION BLVD SUITE 101
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City | COLORADO SPGS
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State | CO
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Zip | 80918-1969
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Country | US
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Telephone | 719-260-5525
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Fax |
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Provider Business Mailing Address
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Address Line | 5525 N UNION BLVD SUITE 101
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City | COLORADO SPGS
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State | CO
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Zip | 80918-1969
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Country | US
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Telephone | 719-260-5525
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LYNN S CASH
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Credential | DC
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Telephone | 719-260-5525
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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 |
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License Number State | CO
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