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General NPI Number Information
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NPI Number | 1700432069
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Entity Type | Organization
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Legal Business Name | BALANCED LIFE CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 08/13/2019
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 606 S 4TH AVE
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City | BRIGHTON
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State | CO
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Zip | 80601-3202
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Country | US
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Telephone | 303-659-7140
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Fax |
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Provider Business Mailing Address
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Address Line | 606 S 4TH AVE
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City | BRIGHTON
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State | CO
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Zip | 80601-3202
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Country | US
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Telephone | 303-659-7140
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MYKOL SOSTARICH
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Credential | DC
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Telephone | 303-659-7140
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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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