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General NPI Number Information
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NPI Number | 1568838647
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Entity Type | Organization
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Legal Business Name | PROPER BALANCE MEDICAL, LLC
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 733 S WELLS ST
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City | CHICAGO
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State | IL
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Zip | 60607-4507
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Country | US
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Telephone | 312-765-0411
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Fax |
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Provider Business Mailing Address
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Address Line | 733 S WELLS ST
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City | CHICAGO
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State | IL
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Zip | 60607-4507
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Country | US
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Telephone | 312-765-0411
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINA KNOX
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Credential | DC
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Telephone | 312-765-0411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 336031676
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License Number State | IL
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