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General NPI Number Information
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NPI Number | 1487086153
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Entity Type | Organization
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Legal Business Name | BALANCED BODY CHIROPRACTIC MN PA
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Dates
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Enumeration Date | 08/05/2013
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Last Update Date | 08/05/2013
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Provider Practice Location Address
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Address Line | 5152 BALMORAL LN
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City | BLOOMINGTON
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State | MN
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Zip | 55437-2800
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Country | US
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Telephone | 952-807-5397
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Fax |
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Provider Business Mailing Address
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Address Line | 5152 BALMORAL LN
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City | BLOOMINGTON
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State | MN
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Zip | 55437-2800
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Country | US
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Telephone | 952-807-5397
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER SKELTON
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Credential | D.C.
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Telephone | 952-807-5397
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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 | 5834
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License Number State | MN
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