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General NPI Number Information
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NPI Number | 1942647284
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Entity Type | Organization
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Legal Business Name | TIMBERLANE CHIROPRACTIC
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Dates
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Enumeration Date | 05/28/2013
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 1996 N FUTURE TER
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City | LECANTO
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State | FL
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Zip | 34461-9341
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Country | US
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Telephone | 352-270-8890
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Fax | 352-270-8890
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Provider Business Mailing Address
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Address Line | 1996 N FUTURE TER
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City | LECANTO
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State | FL
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Zip | 34461-9341
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Country | US
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Telephone | 352-270-8890
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Fax | 352-270-8890
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Authorized Official
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Title or Position | OWNER
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Name | DR. BAMBI BURNETTE BALA
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Credential | D.C.
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Telephone | 352-270-8890
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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 | CH6674
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License Number State | FL
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