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General NPI Number Information
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NPI Number | 1730212242
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Entity Type | Organization
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Legal Business Name | BACK TO BALANCE CHIROPRACTIC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 1158 26TH ST #149
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City | SANTA MONICA
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State | CA
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Zip | 90403-4621
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Country | US
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Telephone | 310-460-7353
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Fax |
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Provider Business Mailing Address
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Address Line | 1158 26TH ST #149
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City | SANTA MONICA
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State | CA
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Zip | 90403-4621
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ERIC BADENER
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Credential | D.C.
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Telephone | 310-460-7353
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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 | DC19698
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License Number State | CA
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