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1881827947 NPI number — DYNAMIC BALANCE WELLNESS, L.L.C

NPI Number: 1881827947
Health Care Provider/Practitioner: DYNAMIC BALANCE WELLNESS, L.L.C

Information about “1881827947” NPI (DYNAMIC BALANCE WELLNESS, L.L.C) exists in 1881827947 in HTML format HTML  |  1881827947 in plain Text format TXT  |  1881827947 in PDF (Portable Document Format) PDF  |  1881827947 in an XML format XML  formats.

NPI Number : 1881827947 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1881827947",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DYNAMIC BALANCE WELLNESS, L.L.C",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "150 HAZARD AVE STE C7",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ENFIELD",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06082-4587",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "860-749-4148",
    "MailingAddressFaxNumber": "860-749-4241",
    "FirstLinePracticeLocationAddress": "150 HAZARD AVE STE C7",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ENFIELD",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06082-4587",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "860-749-4148",
    "PracticeLocationAddressFaxNumber": "860-749-4241",
    "EnumerationDate": "08/24/2009",
    "LastUpdateDate": "08/24/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KELLY",
    "AuthorizedOfficialFirstName": "CRAIG",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LA.C.",
    "AuthorizedOfficialTelephoneNumber": "860-749-4148",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "171100000X",
          "TaxonomyName": "Acupuncturist",
          "LicenseNumber": "000329",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "01590",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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