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General NPI Number Information
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NPI Number | 1588667745
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Entity Type | Organization
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Legal Business Name | BALANCED LIVING CHIROPRACTIC CLINIC, INC
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 708 E SMITH RD
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City | MEDINA
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State | OH
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Zip | 44256-2662
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Country | US
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Telephone | 330-725-5277
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Fax | 330-725-4241
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Provider Business Mailing Address
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Address Line | 708 E SMITH RD
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City | MEDINA
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State | OH
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Zip | 44256-2662
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Country | US
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Telephone | 330-725-5277
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Fax | 330-725-4241
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEANINE A BITSKAY
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Credential | D.C.
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Telephone | 330-725-5277
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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 | 1734
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1685
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License Number State | OH
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