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General NPI Number Information
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NPI Number | 1730211004
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Entity Type | Organization
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Legal Business Name | BALANCE AND SUPPORT DYNAMICS, LLC
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 09/23/2013
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Provider Practice Location Address
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Address Line | 1431 E HARPER AVE
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City | MARYVILLE
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State | TN
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Zip | 37804-3261
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Country | US
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Telephone | 865-984-5588
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Fax | 865-238-0211
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Provider Business Mailing Address
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Address Line | 1431 E HARPER AVE
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City | MARYVILLE
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State | TN
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Zip | 37804-3261
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Country | US
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Telephone | 865-984-5588
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Fax | 865-238-0211
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID ALAN TERRY
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Credential | D.C.
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Telephone | 865-273-2013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 2427
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License Number State | TN
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