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General NPI Number Information
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NPI Number | 1790179976
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Entity Type | Organization
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Legal Business Name | BALANCED BODY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 1231 FARMINGTON LAKES DR SUITE 101
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City | OSWEGO
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State | IL
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Zip | 60543-5109
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Country | US
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Telephone | 331-212-6962
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Fax | 630-429-9276
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Provider Business Mailing Address
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Address Line | 1231 FARMINGTON LAKES DR SUITE 101
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City | OSWEGO
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State | IL
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Zip | 60543-5109
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Country | US
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Telephone | 331-212-6962
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Fax | 630-429-9276
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KRISTEN ACCARDO
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Credential | D.C.
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Telephone | 331-212-6962
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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 | 038012304
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License Number State | IL
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