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General NPI Number Information
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NPI Number | 1861001810
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Entity Type | Organization
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Legal Business Name | BALANCE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 07/27/2020
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 6075 GEMINI DR STE 101
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City | MADISON
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State | WI
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Zip | 53718-3013
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Country | US
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Telephone | 608-338-5901
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Fax |
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Provider Business Mailing Address
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Address Line | 4701 GASTON CIR
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City | COTTAGE GROVE
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State | WI
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Zip | 53527-9765
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Country | US
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Telephone | 608-338-5901
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | AUSTIN KLUTE
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Credential |
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Telephone | 608-338-5901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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