=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851506653
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BALANCING POINT CENTER FOR WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2007
-----------------------------------------------------
Last Update Date | 03/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4753 N BROADWAY ST SUITE 101
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60640-5266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-271-8284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4753 N BROADWAY ST SUITE 101
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60640-5266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-271-8284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KRISTINA CHUNG
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 773-271-8284
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038008534
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------