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General NPI Number Information
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NPI Number | 1861834541
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Entity Type | Organization
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Legal Business Name | BALANCED SPINE AND HEALTH LLC
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Dates
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Enumeration Date | 07/23/2013
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Last Update Date | 07/23/2013
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Provider Practice Location Address
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Address Line | 677 N NEW BALLAS RD STE 220
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City | CREVE COEUR
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State | MO
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Zip | 63141-6732
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Country | US
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Telephone | 314-995-9704
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Fax | 314-995-9732
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Provider Business Mailing Address
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Address Line | 677 N NEW BALLAS RD STE 220
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City | CREVE COEUR
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State | MO
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Zip | 63141-6732
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Country | US
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Telephone | 314-995-9704
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Fax | 314-995-9732
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. SUNG KWANG LEE
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Credential | D.C.
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Telephone | 314-995-9804
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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 | 2009021952
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License Number State | MO
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