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General NPI Number Information
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NPI Number | 1518430289
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Entity Type | Organization
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Legal Business Name | BALANCED BODY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 01/05/2019
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 605 OVERLOOK DR STE 1
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City | WINTER HAVEN
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State | FL
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Zip | 33884-1679
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Country | US
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Telephone | 863-318-9649
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Fax |
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Provider Business Mailing Address
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Address Line | 544 STATE ROAD 559
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City | AUBURNDALE
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State | FL
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Zip | 33823-9384
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Country | US
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Telephone | 863-258-5655
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRENDAN DANIEL MAHONEY
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Credential | DC
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Telephone | 863-318-9649
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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 |
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